Healthcare Provider Details

I. General information

NPI: 1215920699
Provider Name (Legal Business Name): GEORGE WILLIAM URBAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2005
Last Update Date: 08/31/2022
Certification Date: 08/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 NORTH LAKEWOOD ROAD
LAKE IN THE HILLS IL
60156-5945
US

IV. Provider business mailing address

170 NORTH LAKEWOOD ROAD
LAKE IN THE HILLS IL
60156-5945
US

V. Phone/Fax

Practice location:
  • Phone: 224-569-4000
  • Fax: 224-569-4001
Mailing address:
  • Phone: 224-569-4000
  • Fax: 877-686-5642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036086784
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: