Provider Demographics
NPI:1639182355
Name:NEWBERGER, TODD S (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:S
Last Name:NEWBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10024 SKOKIE BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-9945
Mailing Address - Country:US
Mailing Address - Phone:847-475-1333
Mailing Address - Fax:847-869-2932
Practice Address - Street 1:10024 SKOKIE BLVD STE 304
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-9945
Practice Address - Country:US
Practice Address - Phone:847-475-1333
Practice Address - Fax:847-869-2932
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036074095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C44463Medicare UPIN
IL798210Medicare ID - Type Unspecified