Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 036116750 | IL |
NPI | 1306825435 |
---|---|
Provider Name | Monica Kogan |
First Address | Westchester, IL 60154-5701 |
Second Address | Chicago, IL 60612-4861 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 12/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036116750 1 | (05) | IL |
1633878 | BCBS GROUP ID# (01) | IL |
207067 | MEDICARE LOCALITY #16 (01) | IL |
207073 | MEDICARE LOCALITY #15 (01) | IL |
7943309 | AETNA ID# (01) | IL |
I60329 | (02) | IL |