Provider Demographics
NPI:1225471824
Name:GARIBASHVILI, KONSTANTIN (MD)
Entity Type:Individual
Prefix:
First Name:KONSTANTIN
Middle Name:
Last Name:GARIBASHVILI
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 1:1775 W. DEMPSTER ST.
Mailing Address - Street 2:DEPT. OF ANESTHESIA
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1143
Mailing Address - Country:US
Mailing Address - Phone:847-723-1773
Mailing Address - Fax:
Practice Address - Street 1:1775 W. DEMPSTER ST.
Practice Address - Street 2:DEPT. OF ANESTHESIA
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1143
Practice Address - Country:US
Practice Address - Phone:847-723-1773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-12
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.139835207L00000X
IL125063882208600000X
IAMD-44331207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208600000XAllopathic & Osteopathic PhysiciansSurgery