Provider Demographics
NPI:1750511564
Name:GREENBAUM, EVAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:EVAN
Middle Name:S
Last Name:GREENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1900 W POLK ST
Mailing Address - Street 2:SUITE 465
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3723
Mailing Address - Country:US
Mailing Address - Phone:312-864-5233
Mailing Address - Fax:312-864-9638
Practice Address - Street 1:1900 W POLK ST
Practice Address - Street 2:SUITE 465
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3723
Practice Address - Country:US
Practice Address - Phone:312-864-5233
Practice Address - Fax:312-864-9638
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125056125207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology