Provider Demographics
NPI:1609869163
Name:GARBER, VICTOR I (MD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:I
Last Name:GARBER
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 1:901 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:HARVARD
Mailing Address - State:IL
Mailing Address - Zip Code:60033-1821
Mailing Address - Country:US
Mailing Address - Phone:815-943-5431
Mailing Address - Fax:815-943-0659
Practice Address - Street 1:901 GRANT ST
Practice Address - Street 2:
Practice Address - City:HARVARD
Practice Address - State:IL
Practice Address - Zip Code:60033
Practice Address - Country:US
Practice Address - Phone:815-943-5431
Practice Address - Fax:815-943-0659
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-095713207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095713Medicaid
WI4920OtherMERCYCARE INSURANCE
IL036-095713Medicaid
WI1609869163OtherBCBSWI
WI1609869163Medicaid
ILF400493568OtherIL MEDICARE