Healthcare Provider Details

I. General information

NPI: 1679991160
Provider Name (Legal Business Name): GABRIEL JOSE HEIBER BENDAYAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: GABRIEL HEIBER MD

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 CENTRAL AVE STE F-3
WILMETTE IL
60091-2666
US

IV. Provider business mailing address

1100 CENTRAL AVE STE F-3
WILMETTE IL
60091-2666
US

V. Phone/Fax

Practice location:
  • Phone: 312-600-8533
  • Fax:
Mailing address:
  • Phone: 312-600-8533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number036.141460
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number036.141460
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: