1598965360 NPI number — SOFIA DOBRIN MD

Table of content: SOFIA DOBRIN MD (NPI 1598965360)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598965360 NPI number — SOFIA DOBRIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBRIN
Provider First Name:
SOFIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZATS
Provider Other First Name:
SOFIA
Provider Other Middle Name:
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:
1598965360
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 RIDGE AVE
Provider Second Line Business Mailing Address:
EVANSTON HOSPITAL
Provider Business Mailing Address City Name:
EVANSTON
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60201-1718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-570-1206
Provider Business Mailing Address Fax Number:
847-570-1248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2650 RIDGE AVE
Provider Second Line Business Practice Location Address:
NEUROLOGY, BURCH 309
Provider Business Practice Location Address City Name:
EVANSTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60201-1718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-570-2570
Provider Business Practice Location Address Fax Number:
847-570-2073
Provider Enumeration Date:
07/20/2007

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: 2084N0400X , with the licence number:  036-115792 , 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)

  • Identifier: 036-115792 . This is a "IL STATE LIC#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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