Healthcare Provider Details

I. General information

NPI: 1932511516
Provider Name (Legal Business Name): ASHLEY LAUREN COLBERG SABO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2014
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5341
  • Fax:
Mailing address:
  • Phone: 708-684-5341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125.064669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: