MEDICARE: DR. ALEXANDER GARIBASHVILY 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	207Q00000X	Family Medicine Physician	036112246	IL

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	:	1902814452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER GARIBASHVILY M.D.

Provider Business Mailing Address
First Line	:	537 CHARLEMAGNE DR
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2109
Country	:	US
Telephone Number	:	847-850-5377
Fax Number	:	847-850-5378

Provider Business Practice Location Address
First Line	:	200 MILWAUKEE AVE
Second Line	:	SUITE 100
City	:	BUFFALO GROVE
State	:	IL
Zip	:	60089-2812
Country	:	US
Telephone Number	:	847-850-5377
Fax Number	:	847-850-5378

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	09/05/2014

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