Provider Demographics
NPI:1821004854
Name:HERZ, JOSHUA B (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:B
Last Name:HERZ
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 1:2650 RIDGE AVE
Mailing Address - Street 2:EVANSTON HOSPITAL
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-1206
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:2050 PFINGSTEN RD
Practice Address - Street 2:SUITE 280 & 220
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-1324
Practice Address - Country:US
Practice Address - Phone:847-657-1860
Practice Address - Fax:847-657-1890
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114893207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09756Medicare UPIN