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General NPI Number Information
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NPI Number | 1558328955
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Entity Type | Individual
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Provider Name | STEVEN RAY LOBACZ MD
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Gender | Male
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Dates
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Enumeration Date | 04/28/2006
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Last Update Date | 04/16/2010
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Provider Practice Location Address
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Address Line | 1545 W MORSE AVE
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City | CHICAGO
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State | IL
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Zip | 60626-3306
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Country | US
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Telephone | 773-764-5135
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Fax | 773-764-4967
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Provider Business Mailing Address
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Address Line | PO BOX 268312
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City | CHICAGO
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State | IL
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Zip | 60626-8312
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Country | US
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Telephone | 773-764-5135
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Fax | 773-764-4967
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-098563
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License Number State | IL
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