Provider Demographics
NPI:1225214323
Name:DAVID J COYNIK, MD,PC
Entity type:Organization
Organization Name:DAVID J COYNIK, MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:COYNIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-223-6975
Mailing Address - Street 1:4413 N. PROGRESS BLVD.
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:IL
Mailing Address - Zip Code:61354-2763
Mailing Address - Country:US
Mailing Address - Phone:815-223-6975
Mailing Address - Fax:815-223-0640
Practice Address - Street 1:4413 N. PROGRESS BLVD.
Practice Address - Street 2:
Practice Address - City:PERU
Practice Address - State:IL
Practice Address - Zip Code:61354-2763
Practice Address - Country:US
Practice Address - Phone:815-223-6975
Practice Address - Fax:815-223-0640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055725261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC4534Medicare UPIN