Healthcare Provider Details

I. General information

NPI: 1316990104
Provider Name (Legal Business Name): HENRY S LOEB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EDWARD HINES VA HOSPITAL ROOSEVELT RD.
MAYWOOD IL
60141
US

IV. Provider business mailing address

781 SHERIDAN RD
HIGHLAND PARK IL
60035-4703
US

V. Phone/Fax

Practice location:
  • Phone: 708-202-2700
  • Fax:
Mailing address:
  • Phone: 708-202-8387
  • Fax: 708-202-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: