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General NPI Number Information
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NPI Number | 1881647048
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Entity Type | Individual
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Provider Name | JOHN R HAEBICH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/18/2006
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 3825 N CENTRAL AVE
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City | CHICAGO
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State | IL
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Zip | 60634-2719
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Country | US
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Telephone | 773-282-6188
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Fax | 773-282-7389
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Provider Business Mailing Address
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Address Line | 360 W BUTTERFIELD RD STE 325
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City | ELMHURST
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State | IL
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Zip | 60126-5088
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Country | US
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Telephone | 773-282-6188
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Fax | 773-282-7389
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 036069235
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License Number State | IL
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