Provider Demographics
NPI:1336138726
Name:OLIFF, IRA A (MD)
Entity Type:Individual
Prefix:
First Name:IRA
Middle Name:A
Last Name:OLIFF
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 1:62311 COLLECTION CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60693-0623
Mailing Address - Country:US
Mailing Address - Phone:847-568-9930
Mailing Address - Fax:847-568-9932
Practice Address - Street 1:9711 SKOKIE BLVD
Practice Address - Street 2:STE A
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1384
Practice Address - Country:US
Practice Address - Phone:847-568-9930
Practice Address - Fax:847-568-9932
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098898207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098898Medicaid
ILL91234Medicare PIN
ILG06649Medicare UPIN
ILL71833Medicare PIN
IL830005993Medicare PIN