Provider Demographics
NPI:1679163547
Name:COKLOW CONSULTING GROUP, CORP.
Entity Type:Organization
Organization Name:COKLOW CONSULTING GROUP, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:NGU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-250-8424
Mailing Address - Street 1:5030 N MARINE DR APT 806
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-3372
Mailing Address - Country:US
Mailing Address - Phone:773-597-7698
Mailing Address - Fax:
Practice Address - Street 1:5030 N MARINE DR APT 806
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-3372
Practice Address - Country:US
Practice Address - Phone:773-597-7698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-24
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental