Provider Demographics
NPI:1467794248
Name:KIRSHENBAUM, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:KIRSHENBAUM
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 1:1800 HOLLISTER DR STE 107
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5265
Mailing Address - Country:US
Mailing Address - Phone:847-295-0010
Mailing Address - Fax:847-549-7815
Practice Address - Street 1:1800 HOLLISTER DR STE 107
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5265
Practice Address - Country:US
Practice Address - Phone:847-295-0010
Practice Address - Fax:847-549-7815
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036145575208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty