Provider Demographics
NPI:1275656340
Name:KOYNER, JAY LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:LAWRENCE
Last Name:KOYNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:SUITE S-506, MC 5100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-4842
Mailing Address - Fax:773-702-5818
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:SUITE S-506, MC 5100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-4842
Practice Address - Fax:773-702-5818
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology