Provider Demographics
NPI:1407867930
Name:LOEB, CAROLINE ANN
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANN
Last Name:LOEB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 N MICHIGAN AVENUE
Mailing Address - Street 2:SUITE 1200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-373-7300
Mailing Address - Fax:312-573-1249
Practice Address - Street 1:737 N MICHIGAN AVENUE
Practice Address - Street 2:SUITE 1200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-373-7300
Practice Address - Fax:312-573-1249
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036 1019292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL260050206OtherRAILROAD MEDICARE
IL01615704OtherBLUE CROSS BLUE SHIELD
IL036101929Medicaid
IL036101929Medicaid
IL260050206OtherRAILROAD MEDICARE
H18673Medicare UPIN