Individual
RICARDO D KOHN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
750 E TERRA COTTA AVE STE A, CRYSTAL LAKE, IL 60014
(815) 455-1800
(815) 455-1875
Mailing address
750 E TERRA COTTA AVE STE A, CRYSTAL LAKE, IL 60014-3621
(815) 455-1800
(815) 455-1875
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
036-087378
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01633648
BCBS PROVIDER ID
IL
01
—
036087378
STATE LICENSE
IL
05
—
036087378
—
IL
01
—
P00057296
RAIL ROAD MEDICARE
IL
Enumeration date
09/20/2005
Last updated
10/19/2018
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