Individual
MR. MICHAEL D COULSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1 KISH HOSPITAL DRIVE, DEKALB, IL 60115-9602
(815) 756-1521
(815) 748-8395
Mailing address
1 KISH HOSPITAL DRIVE, DEKALB, IL 60115-9602
(815) 756-1521
(815) 748-8395
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036.077834
IL
207L00000X
Anesthesiology Physician
336.040926
IL
207LP2900X
Pain Medicine (Anesthesiology) Physician
036077834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077834
—
IL
01
—
050082135
RAILROAD MEDICARE
IL
Enumeration date
06/30/2005
Last updated
07/14/2010
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