Healthcare Provider Details

I. General information

NPI: 1538185095
Provider Name (Legal Business Name): ARNOLD M HERSKOVIC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR 418
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR 418
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 312-654-0051
  • Fax: 312-942-2894
Mailing address:
  • Phone: 312-654-0051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036097303
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number5146-320
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036097303
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberEMC0006393
License Number StateMI
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036097303
License Number StateIL
# 6
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number036-097303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: