Provider Demographics
NPI:1114986676
Name:UBATUBA, JOAO GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:JOAO
Middle Name:GABRIEL
Last Name:UBATUBA
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 1:777 OAKMONT LN
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:WESTMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60559-5511
Mailing Address - Country:US
Mailing Address - Phone:630-789-2550
Mailing Address - Fax:
Practice Address - Street 1:1200 S YORK RD
Practice Address - Street 2:SUITE 3290
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5626
Practice Address - Country:US
Practice Address - Phone:630-516-9120
Practice Address - Fax:630-516-9124
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01616966OtherBCBS PROVIDER ID
ILL77515Medicare PIN
IL01616966OtherBCBS PROVIDER ID
ILP04733Medicare PIN