Healthcare Provider Details

I. General information

NPI: 1619047834
Provider Name (Legal Business Name): CUMBERLAND PHYSICAL MEDICINE LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 09/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 NORTH CUMBERLAND AVE STE 1 3A CUMBERLAND PHYSICAL MEDICINE
NORRIDGE IL
60706
US

IV. Provider business mailing address

4701 N CUMBERLAND AVE STE 1 3A
NORRIDGE IL
60706-2905
US

V. Phone/Fax

Practice location:
  • Phone: 708-452-4444
  • Fax: 708-452-7090
Mailing address:
  • Phone: 708-452-4444
  • Fax: 708-452-7090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number038007471
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036088148
License Number StateIL

VIII. Authorized Official

Name: WALTER ANTHONY KARBOWSKI
Title or Position: DIRECTOR
Credential: DC
Phone: 708-452-4444