Provider Demographics
NPI:1366550485
Name:KOLBUSZ, WILLIAM EDWARD
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWARD
Last Name:KOLBUSZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0202290459OtherASSURANT HEALTH
IL202290459 0001OtherCIGNA ID
IL63310OtherADVOCATE HEALTH PARTNERS
IL0002232794OtherBLUE CROSS BLUE SHIELD ID
IL0202290459OtherTIME INSURANCE COMPANY
IL63310OtherADVOCATE HEALTH PARTNERS
IL0002232794OtherBLUE CROSS BLUE SHIELD ID
IL0202290459OtherASSURANT HEALTH
IL202290459 0001OtherCIGNA ID