Healthcare Provider Details

I. General information

NPI: 1053338798
Provider Name (Legal Business Name): HARVEY DEBOFSKY MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 E 93RD ST SUITE 200
CHICAGO IL
60617-3936
US

IV. Provider business mailing address

2315 E 93RD ST SUITE 200
CHICAGO IL
60617-3936
US

V. Phone/Fax

Practice location:
  • Phone: 773-734-3970
  • Fax: 773-734-6832
Mailing address:
  • Phone: 773-734-3970
  • Fax: 773-734-6832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036035346
License Number StateIL

VIII. Authorized Official

Name: LYNNETTE MCROY
Title or Position: BILLING COORDINATOR
Credential:
Phone: 773-767-3822