Provider Demographics
NPI:1760618524
Name:GLENN I CABIN M D S C
Entity Type:Organization
Organization Name:GLENN I CABIN M D S C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:D
Authorized Official - Last Name:CABIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-635-1005
Mailing Address - Street 1:1400 E GOLF ROAD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016
Mailing Address - Country:US
Mailing Address - Phone:847-635-1005
Mailing Address - Fax:847-635-1570
Practice Address - Street 1:1400 E. GOLF ROAD
Practice Address - Street 2:SUITE 211
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60016
Practice Address - Country:US
Practice Address - Phone:847-635-1005
Practice Address - Fax:847-635-1570
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENN I CABIN M D S C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-08
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3641739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39649Medicare PIN
IL473151Medicare PIN