Provider Demographics
NPI:1821176140
Name:HERBAS, OSCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:HERBAS
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 1:37 STONE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-7706
Mailing Address - Country:US
Mailing Address - Phone:630-243-9890
Mailing Address - Fax:
Practice Address - Street 1:2701 W 68TH ST
Practice Address - Street 2:PHYSICIANS PAVILION, SUITE 352
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-1813
Practice Address - Country:US
Practice Address - Phone:630-243-9890
Practice Address - Fax:630-257-8805
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-048716208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036048716Medicaid
IL036048716Medicaid
IL492910Medicare ID - Type Unspecified