Individual
GARY L KOEHN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
5201 WILLOW SPRINGS RD, SUITE 110, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 482-4500
(708) 482-4502
Mailing address
5201 WILLOW SPRINGS RD, SUITE 110, LA GRANGE HIGHLANDS, IL 60525-6537
(708) 482-4500
(708) 482-4502
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
25969
WI
207LP2900X
Pain Medicine (Anesthesiology) Physician
036074138
IL
208VP0014X
Interventional Pain Medicine Physician
Primary
036074138
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01608719
BLUE CROSS PROVIDER NO.
IL
01
—
030038
HEALTH ALLIANCE ID
IL
01
—
1164451308
GL KOEHN ASSOC GROUP NPI
IL
01
—
132321800
US DEPT OF LABOR GROUP
IL
Enumeration date
05/18/2006
Last updated
11/08/2012
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