Provider Demographics
NPI:1114034071
Name:GARLOVSKY, IRVING SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:IRVING
Middle Name:SAMUEL
Last Name:GARLOVSKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2320 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5242
Mailing Address - Country:US
Mailing Address - Phone:773-973-0188
Mailing Address - Fax:773-973-0499
Practice Address - Street 1:2320 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-5242
Practice Address - Country:US
Practice Address - Phone:773-973-0188
Practice Address - Fax:773-973-0499
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC38894Medicare UPIN
IL494860Medicare ID - Type UnspecifiedMEDICARE