Provider Demographics
NPI:1518966811
Name:HERBSTMAN, ARNOLD J (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNOLD
Middle Name:J
Last Name:HERBSTMAN
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 1:1710 N RANDALL RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-9401
Mailing Address - Country:US
Mailing Address - Phone:847-888-0750
Mailing Address - Fax:847-888-2152
Practice Address - Street 1:1710 N RANDALL RD
Practice Address - Street 2:SUITE 140
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-9401
Practice Address - Country:US
Practice Address - Phone:847-888-0750
Practice Address - Fax:847-888-2152
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-052271207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0451517835OtherBLUE SHIELD
IL036052271Medicaid
200008161OtherRR MEDICARE
200040072OtherRR MEDICARE
IL036052271Medicaid
200040072OtherRR MEDICARE
569620Medicare ID - Type Unspecified
643380Medicare ID - Type Unspecified