Individual
DOUGLAS KOLTUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4400 W 95TH ST STE 306, OAK LAWN, IL 60453-2659
(708) 684-5428
(708) 684-2079
Mailing address
777 OAKMONT LN, SUITE 1600, WESTMONT, IL 60559-5511
(630) 789-2550
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
036070752
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621490
BCBS PROVIDER ID
IL
05
—
036070752
—
IL
01
—
131667300
WORKERS COMPENSATION
IL
01
—
250002469
RAILROAD MEDICARE
IL
01
—
36354817305
ADVOCATE HLTH CENTERS ID
IL
01
—
47614
ADVOCATE HLTH PARTNERS ID
IL
Enumeration date
09/21/2005
Last updated
12/15/2021
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