Provider Demographics
NPI:1598832925
Name:GARY J HOBERMAN DPM & ASSOCIATES
Entity Type:Organization
Organization Name:GARY J HOBERMAN DPM & ASSOCIATES
Other - Org Name:PODIATRY PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOBERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-775-0300
Mailing Address - Street 1:6560 W HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60656-2161
Mailing Address - Country:US
Mailing Address - Phone:773-775-0300
Mailing Address - Fax:773-775-0883
Practice Address - Street 1:6560 W HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-2161
Practice Address - Country:US
Practice Address - Phone:773-775-0300
Practice Address - Fax:773-775-0883
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GARY J HOBERMAN DPM & ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-29
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL685971Medicare PIN