1780729079 NPI number — DR. LAURA ELIZABETH BOE-KNOLL AU.D.

Table of content: DR. LAURA ELIZABETH BOE-KNOLL AU.D. (NPI 1780729079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780729079 NPI number — DR. LAURA ELIZABETH BOE-KNOLL AU.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BOE-KNOLL
Provider First Name:
LAURA
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AU.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOE
Provider Other First Name:
LAURA
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780729079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
462 W. HAF DAY ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BUFFALO GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60089-6555
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-276-2735
Provider Business Mailing Address Fax Number:
847-276-2733

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
462 W. HAF DAY ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-6555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-276-2735
Provider Business Practice Location Address Fax Number:
847-276-2733
Provider Enumeration Date:
02/21/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231HA2400X , with the licence number:  147-001399 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231HA2500X , with the licence number: 147001399 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 147-001399 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 174-001399 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)