Provider Demographics
NPI:1144369927
Name:ALEXANDER E OBOLSKY MD PC
Entity type:Organization
Organization Name:ALEXANDER E OBOLSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:OBOLOSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-456-4343
Mailing Address - Street 1:100 W MONROE ST
Mailing Address - Street 2:SUITE 1107
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-1967
Mailing Address - Country:US
Mailing Address - Phone:312-456-4343
Mailing Address - Fax:312-456-8304
Practice Address - Street 1:100 W MONROE ST
Practice Address - Street 2:SUITE 1107
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-1967
Practice Address - Country:US
Practice Address - Phone:312-456-4343
Practice Address - Fax:312-456-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360810742084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty