1821164492 NPI number — DR. JOAN WERBER DO

Table of content: DR. JOAN WERBER DO (NPI 1821164492)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821164492 NPI number — DR. JOAN WERBER DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WERBER
Provider First Name:
JOAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WERBER
Provider Other First Name:
JOAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821164492
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
60 EAST DELAWARE PLACE
Provider Second Line Business Mailing Address:
SUITE 1410
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60611-6559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
312-867-9000
Provider Business Mailing Address Fax Number:
312-867-9127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 EAST DELAWARE PLACE
Provider Second Line Business Practice Location Address:
SUITE 1410
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60611-6559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
312-867-9000
Provider Business Practice Location Address Fax Number:
312-867-9127
Provider Enumeration Date:
11/27/2006

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: 174400000X , with the licence number:  036062483 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X , with the licence number: 036062483 , 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)