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General NPI Number Information
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NPI Number | 1447457122
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Entity Type | Individual
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Provider Name | JOSHUA JOSPEH HERSKOVIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2007
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Last Update Date | 12/30/2019
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Provider Practice Location Address
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Address Line | 2520 ELISHA AVE
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City | ZION
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State | IL
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Zip | 60099-2676
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Country | US
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Telephone | 847-872-4890
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 MALORY LN
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-1626
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Country | US
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Telephone | 847-922-1079
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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 | 036.121084
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 52138-020
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License Number State | WI
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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 | ME141023
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License Number State | FL
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