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General NPI Number Information
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NPI Number | 1144369927
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Entity Type | Organization
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Legal Business Name | ALEXANDER E OBOLSKY MD PC
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 100 W MONROE ST SUITE 1107
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City | CHICAGO
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State | IL
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Zip | 60603-1967
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Country | US
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Telephone | 312-456-4343
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Fax | 312-456-8304
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Provider Business Mailing Address
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Address Line | 100 W MONROE ST SUITE 1107
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City | CHICAGO
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State | IL
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Zip | 60603-1967
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Country | US
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Telephone | 312-456-4343
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Fax | 312-456-8304
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEXANDER EDWARD OBOLOSKY
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Credential | MD
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Telephone | 312-456-4343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036081074
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License Number State | IL
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