Healthcare Provider Details

I. General information

NPI: 1700038874
Provider Name (Legal Business Name): IRA S. HALPER, M.D. S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 958
CHICAGO IL
60612-3862
US

IV. Provider business mailing address

1725 W HARRISON ST STE 958
CHICAGO IL
60612-3862
US

V. Phone/Fax

Practice location:
  • Phone: 312-226-0300
  • Fax:
Mailing address:
  • Phone: 312-226-0300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. IRA S. HALPER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 312-226-0300