Provider Demographics
NPI:1487663431
Name:WESTBROOK INTERNAL MEDICINE, S.C.
Entity Type:Organization
Organization Name:WESTBROOK INTERNAL MEDICINE, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-884-7111
Mailing Address - Street 1:1555 N BARRINGTON RD
Mailing Address - Street 2:SUITE 505
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60169-1066
Mailing Address - Country:US
Mailing Address - Phone:847-884-7111
Mailing Address - Fax:847-884-7156
Practice Address - Street 1:1555 N BARRINGTON RD
Practice Address - Street 2:SUITE 505
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60169-1066
Practice Address - Country:US
Practice Address - Phone:847-884-7111
Practice Address - Fax:847-884-7156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31603039OtherBCBS
ILG75488Medicare UPIN
962420Medicare ID - Type Unspecified
ILC41365Medicare UPIN
IL31603039OtherBCBS
ILG23733Medicare UPIN