MEDICARE: ERIN M IBLER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician	036.139264	IL

General Provider Information

NPI Number	:	1013354810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN M IBLER M.D.

Provider Business Mailing Address
First Line	:	2148 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4562
Country	:	US
Telephone Number	:	773-938-8128
Fax Number	:	773-938-8126

Provider Business Practice Location Address
First Line	:	2148 N DAMEN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4562
Country	:	US
Telephone Number	:	773-938-8128
Fax Number	:	773-938-8126

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	07/27/2023

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