Healthcare Provider Details

I. General information

NPI: 1699877175
Provider Name (Legal Business Name): DAVID A LORBER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 SKOKIE BLVD SUITE J
SKOKIE IL
60077-1384
US

IV. Provider business mailing address

9711 SKOKIE BLVD SUITE J
SKOKIE IL
60077-1384
US

V. Phone/Fax

Practice location:
  • Phone: 847-675-9711
  • Fax: 847-675-9714
Mailing address:
  • Phone: 847-675-9711
  • Fax: 847-675-9714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036-066262
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: