Provider Demographics
NPI:1124005756
Name:HEBEL, DONALD JOHN (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JOHN
Last Name:HEBEL
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 1:1275 E BELVIDERE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2082
Mailing Address - Country:US
Mailing Address - Phone:847-918-1462
Mailing Address - Fax:847-968-4311
Practice Address - Street 1:1275 E BELVIDERE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2082
Practice Address - Country:US
Practice Address - Phone:847-918-1462
Practice Address - Fax:847-968-4311
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0930062085R0202X
WI447692085R0202X
IN01059696A2085R0202X
VA01012410602085R0202X
WAMD000475152085R0202X
WV226652085R0202X
OH35.0910872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL202926OtherGROUP PTAN
IL036093006Medicaid
WI34395300Medicaid
IL212545OtherGROUP PTAN
ILL97410Medicare PIN
ILK28484Medicare PIN
ILH01649Medicare UPIN
ILL74498Medicare PIN
IL300106544Medicare PIN
ILK06063Medicare PIN
IL202926OtherGROUP PTAN
IL036093006Medicaid
WI34395300Medicaid
ILL93769Medicare PIN
ILK45889Medicare PIN
IL212545017Medicare PIN