Provider Demographics
NPI:1316219736
Name:ALLZ FAMILY PRACTICE PHYSICIANS, SC
Entity Type:Organization
Organization Name:ALLZ FAMILY PRACTICE PHYSICIANS, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-438-2144
Mailing Address - Street 1:350 SURRYSE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-3217
Mailing Address - Country:US
Mailing Address - Phone:847-438-2144
Mailing Address - Fax:847-719-0335
Practice Address - Street 1:1345 RYAN PKWY
Practice Address - Street 2:
Practice Address - City:ALGONQUIN
Practice Address - State:IL
Practice Address - Zip Code:60102-4530
Practice Address - Country:US
Practice Address - Phone:847-658-9555
Practice Address - Fax:847-658-2167
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-31
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619902207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty