MEDICARE: THEODORE T. FABER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084N0400X	Neurology Physician	14276	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	E137269482	OTHER	SC	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558372995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THEODORE T. FABER M.D.

Provider Business Mailing Address
First Line	:	2045 W GRAND AVE STE B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1577
Country	:	US
Telephone Number	:	708-630-1534
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 W GRAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-1576
Country	:	US
Telephone Number	:	86-301-5347
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2006
Last Update Date	:	09/08/2022

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