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NPI Code Detail

MEDICARE: ERIC A GIEBELHAUSEN MD

MEDICARE:   ERIC A GIEBELHAUSEN  MD
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
1174400000XSpecialist036051855IL
2207W00000XOphthalmology Physician036051855IL

Other Identifiers

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

General Provider Information

NPI Number : 1790715662
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC A GIEBELHAUSEN MD
Provider Business Mailing Address
First Line : 2020 W ILES AVE
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62704-7015
Country : US
Telephone Number : 217-698-3030
Fax Number : 217-698-4728
Provider Business Practice Location Address
First Line : 2000 W MORTON AVE
Second Line :
City : JACKSONVILLE
State : IL
Zip : 62650-2623
Country : US
Telephone Number : 217-245-6814
Fax Number : 217-245-0375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/04/2006
Last Update Date : 01/14/2014

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Directions to “ ERIC A GIEBELHAUSEN MD” Practice Location

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