Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | 036130405 | IL |
NPI | 1235286022 |
---|---|
Provider Name | Felicitas Koller |
First Address | Chicago, IL 60611-2927 |
Second Address | Chicago, IL 60611-2927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2007 |
Last Update Date | 08/06/2014 |