Provider Demographics
NPI:1336323955
Name:WILLIAM E. KOLBUSZ, M.D., S.C.
Entity Type:Organization
Organization Name:WILLIAM E. KOLBUSZ, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATYE
Authorized Official - Middle Name:
Authorized Official - Last Name:ASELTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-964-3839
Mailing Address - Street 1:1034 WARREN AVE
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-3601
Mailing Address - Country:US
Mailing Address - Phone:630-964-3839
Mailing Address - Fax:630-964-5105
Practice Address - Street 1:1034 WARREN AVE
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-3601
Practice Address - Country:US
Practice Address - Phone:630-964-3839
Practice Address - Fax:630-964-5105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C37127Medicare UPIN
IL211629Medicare PIN
K17387Medicare PIN