Basic Information
| Provider Information | |||||||||
| NPI: | 1487714804 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOIL | ||||||||
| FirstName: | ALWYN | ||||||||
| MiddleName: | AJITRAJ | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9201 MONTGOMERY BLVD NE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871112468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052982505 | ||||||||
| FaxNumber: | 5052982985 | ||||||||
| Practice Location | |||||||||
| Address1: | 9201 MONTGOMERY BLVD NE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871112468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052982505 | ||||||||
| FaxNumber: | 5052982985 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 2003-0567 | NM | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.