Provider Demographics
NPI:1669638979
Name:PAZ-AVERBUCH, BEATRISA (MD)
Entity Type:Individual
Prefix:DR
First Name:BEATRISA
Middle Name:
Last Name:PAZ-AVERBUCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BEA/BEATRISA
Other - Middle Name:
Other - Last Name:PAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4860 OAKTON ST
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-2953
Mailing Address - Country:US
Mailing Address - Phone:847-329-0470
Mailing Address - Fax:847-329-0472
Practice Address - Street 1:4860 W. OAKTON STR.
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077
Practice Address - Country:US
Practice Address - Phone:847-329-0470
Practice Address - Fax:847-329-0472
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036124447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03612447Medicaid
ILIL3044Medicare PIN