Provider Demographics
NPI:1114119245
Name:PAUL M. BAUBLY, M.D. S. C.
Entity Type:Organization
Organization Name:PAUL M. BAUBLY, M.D. S. C.
Other - Org Name:CENTER STREET MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-595-9988
Mailing Address - Street 1:103 N HAVEN RD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2973
Mailing Address - Country:US
Mailing Address - Phone:630-595-9988
Mailing Address - Fax:313-225-2296
Practice Address - Street 1:103 N HAVEN RD FL 2
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2973
Practice Address - Country:US
Practice Address - Phone:630-595-9988
Practice Address - Fax:331-225-2296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082085261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082085Medicaid
IL036082085Medicaid
IL209599Medicare PIN