1417940610 NPI number — DR. ALEXANDER ADAM ESCHBACH PH.D.

Table of content: DR. ALEXANDER ADAM ESCHBACH PH.D. (NPI 1417940610)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417940610 NPI number — DR. ALEXANDER ADAM ESCHBACH PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESCHBACH
Provider First Name:
ALEXANDER
Provider Middle Name:
ADAM
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417940610
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 E. WOODFIELD ROAD
Provider Second Line Business Mailing Address:
SUITE 610
Provider Business Mailing Address City Name:
SCHAUMBURG
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60173
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-240-0444
Provider Business Mailing Address Fax Number:
847-240-0446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 GRAND CANYON PKWY
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60194-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-755-0555
Provider Business Practice Location Address Fax Number:
847-755-0580
Provider Enumeration Date:
08/24/2005

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: 103G00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1622330 . This is a "BLUE CROSS / BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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