1609869163 NPI number — VICTOR I GARBER MD

Table of content: VICTOR I GARBER MD (NPI 1609869163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609869163 NPI number — VICTOR I GARBER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GARBER
Provider First Name:
VICTOR
Provider Middle Name:
I
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1609869163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 GRANT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARVARD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60033-1821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-943-5431
Provider Business Mailing Address Fax Number:
815-943-0659

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 GRANT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARVARD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-943-5431
Provider Business Practice Location Address Fax Number:
815-943-0659
Provider Enumeration Date:
08/30/2005

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: 207P00000X , with the licence number:  036-095713 , 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: 036095713 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4920 . This is a "MERCYCARE INSURANCE" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 036-095713 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1609869163 . This is a "BCBSWI" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 1609869163 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: F400493568 . This is a "IL MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com