1396912721 NPI number — TOBIAS HEALING INSTITUTE LLC

Table of content: (NPI 1396912721)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396912721 NPI number — TOBIAS HEALING INSTITUTE LLC

Organization/Personal Information

Employer Identification Number (EIN):
N/A
Provider Organization Name:
TOBIAS HEALING INSTITUTE LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
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Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
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Provider Other Last Name:
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Provider Other Middle Name:
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NPI Number Information

NPI Number:
1396912721
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 LAKE ST
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60301-1049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-848-1200
Provider Business Mailing Address Fax Number:
708-848-1201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 LAKE ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
OAK PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60301-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-848-1200
Provider Business Practice Location Address Fax Number:
708-848-1201
Provider Enumeration Date:
05/14/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TOBIAS
Authorized Official First Name:
FELICITAS
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
708-848-1200

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036035805 , 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)