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General NPI Number Information
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NPI Number | 1316920358
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Entity Type | Individual
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Provider Name | ILYA M AVERBUCH M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 11/12/2018
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Provider Practice Location Address
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Address Line | 1000 HEALTH CENTER DR
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City | MATTOON
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State | IL
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Zip | 61938
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Country | US
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Telephone | 217-258-2440
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Fax | 217-258-2186
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Provider Business Mailing Address
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Address Line | 1005 HEALTH CENTER DR STE 201
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City | MATTOON
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State | IL
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Zip | 61938-4693
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Country | US
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Telephone | 217-238-6055
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | MD032400E
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD032400E
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 036-068971
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License Number State | IL
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