Provider Demographics
NPI:1609861657
Name:INGBERMAN, DINORA (MD)
Entity Type:Individual
Prefix:
First Name:DINORA
Middle Name:
Last Name:INGBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9669 N. KENTON ST
Mailing Address - Street 2:510
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1545
Mailing Address - Country:US
Mailing Address - Phone:847-675-1064
Mailing Address - Fax:
Practice Address - Street 1:9669 KENTON AVE
Practice Address - Street 2:SUITE 405
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1266
Practice Address - Country:US
Practice Address - Phone:630-789-2550
Practice Address - Fax:847-675-7595
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-083386208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00198132OtherRAIL ROAD MEDICARE
IL260037069OtherRAIL ROAD MEDICARE
IL01622674OtherBCBS PROVIDER ID
IL036083386Medicaid
IL260037069Medicare PIN
IL516460Medicare PIN
IL260037069OtherRAIL ROAD MEDICARE
ILP00198132OtherRAIL ROAD MEDICARE
IL036083386Medicaid