Healthcare Provider Details

I. General information

NPI: 1689688566
Provider Name (Legal Business Name): HARVEY DEBOFSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
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:
Mailing address:
  • Phone: 773-734-3970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: