Provider Demographics
NPI:1124161633
Name:KORONELL ENTERPRISES INC
Entity type:Organization
Organization Name:KORONELL ENTERPRISES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NELLIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:AKOMAS-IKORO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-316-5222
Mailing Address - Street 1:601 N WILLIAMS ST
Mailing Address - Street 2:B-1
Mailing Address - City:THORNTON
Mailing Address - State:IL
Mailing Address - Zip Code:60476-1097
Mailing Address - Country:US
Mailing Address - Phone:708-316-5222
Mailing Address - Fax:708-316-5220
Practice Address - Street 1:601 N WILLIAMS ST
Practice Address - Street 2:B-1
Practice Address - City:THORNTON
Practice Address - State:IL
Practice Address - Zip Code:60476-1097
Practice Address - Country:US
Practice Address - Phone:708-316-5222
Practice Address - Fax:708-316-5220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000874332BD1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========004Medicaid
IL6585480001Medicare NSC