Provider Demographics
NPI:1134137698
Name:KOSKAN, ELIZABETH PAULINE (MS, ATC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:PAULINE
Last Name:KOSKAN
Suffix:
Gender:F
Credentials:MS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 S INDIANA AVE
Mailing Address - Street 2:#313
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-1391
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1601 S INDIANA AVE
Practice Address - Street 2:#313
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-1391
Practice Address - Country:US
Practice Address - Phone:312-212-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL960018012255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer