Provider Demographics
NPI:1235286022
Name:KOLLER, FELICITAS (MD)
Entity Type:Individual
Prefix:
First Name:FELICITAS
Middle Name:
Last Name:KOLLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 N SAINT CLAIR ST
Mailing Address - Street 2:SUITE 1900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2927
Mailing Address - Country:US
Mailing Address - Phone:312-695-8900
Mailing Address - Fax:312-695-9194
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 1900
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-695-8900
Practice Address - Fax:312-695-9194
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2014-06-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036130405204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery