Provider Demographics
NPI:1851589428
Name:KOKITY, PAL LOUIS
Entity Type:Individual
Prefix:
First Name:PAL
Middle Name:LOUIS
Last Name:KOKITY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:887 CROSS CREEK CT
Mailing Address - Street 2:DD
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-3675
Mailing Address - Country:US
Mailing Address - Phone:630-220-8550
Mailing Address - Fax:
Practice Address - Street 1:887 CROSS CREEK CT
Practice Address - Street 2:DD
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-3675
Practice Address - Country:US
Practice Address - Phone:630-220-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227.007777174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist