Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036089628 | IL |
NPI | 1043225899 |
---|---|
Provider Name | Kevin M Koutsky |
First Address | Hinsdale, IL 60521-8608 |
Second Address | Hinsdale, IL 60521-8608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2006 |
Last Update Date | 27/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036089628 | (05) | IL |
036089628 | LICENSE (01) | IL |
G68033 | (02) | IL |