Basic Information
Provider Information
NPI: 1730104746
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: COX
FirstName: KAREN
MiddleName: L
NamePrefix:  
NameSuffix:  
Credential: PA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 900 RAND RD
Address2: SUITE 120
City: DES PLAINES
State: IL
PostalCode: 600162359
CountryCode: US
TelephoneNumber: 8478233185
FaxNumber:  
Practice Location
Address1: 900 RAND RD
Address2: SUITE 120
City: DES PLAINES
State: IL
PostalCode: 600162359
CountryCode: US
TelephoneNumber: 8478233185
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/12/2006
LastUpdateDate: 05/11/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X085-002489ILY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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