Healthcare Provider Details

I. General information

NPI: 1033510615
Provider Name (Legal Business Name): EDUARD OBOLSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 OAK ST APT 301
WINNETKA IL
60093-2559
US

IV. Provider business mailing address

812 OAK ST APT 301
WINNETKA IL
60093-2559
US

V. Phone/Fax

Practice location:
  • Phone: 847-501-3658
  • Fax:
Mailing address:
  • Phone: 847-501-3658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036068442
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: