Healthcare Provider Details

I. General information

NPI: 1972828002
Provider Name (Legal Business Name): ELIZABETH ANNE DOBLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2010
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2650 RIDGE AVE. PEDIATRIC HOSPITALIST
EVANSTON IL
60201-1718
US

IV. Provider business mailing address

2650 RIDGE AVE. PEDIATRIC HOSPITALIST
EVANSTON IL
60201-1718
US

V. Phone/Fax

Practice location:
  • Phone: 847-570-1438
  • Fax: 847-984-5619
Mailing address:
  • Phone: 847-570-1438
  • Fax: 847-984-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036136247
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036136247
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: