Provider Demographics
NPI:1407906696
Name:SILBERMAN, CARL M (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:M
Last Name:SILBERMAN
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 1:1870 W WINCHESTER RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5365
Mailing Address - Country:US
Mailing Address - Phone:847-224-0165
Mailing Address - Fax:815-462-4955
Practice Address - Street 1:1870 W WINCHESTER RD STE 112
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5365
Practice Address - Country:US
Practice Address - Phone:847-224-0165
Practice Address - Fax:847-367-7345
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036056039174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036056039Medicaid
IL774030Medicare PIN
IL036056039Medicaid