Provider Demographics
NPI:1447220942
Name:SOBINSKY, KIM R (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:R
Last Name:SOBINSKY
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 1:800 N WESTMORELAND RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1673
Mailing Address - Country:US
Mailing Address - Phone:847-234-4310
Mailing Address - Fax:847-234-4336
Practice Address - Street 1:800 N WESTMORELAND RD
Practice Address - Street 2:SUITE 205
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1673
Practice Address - Country:US
Practice Address - Phone:847-234-4310
Practice Address - Fax:847-234-4336
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC48468Medicare UPIN
IL757480Medicare ID - Type Unspecified