Provider Demographics
NPI:1831296474
Name:BERLIN, GABRIEL IRA (MD)
Entity Type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:IRA
Last Name:BERLIN
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 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-998-5700
Mailing Address - Fax:847-998-5795
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-998-5700
Practice Address - Fax:847-998-5795
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-053249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01638042OtherBLUE CROSS/BLUE SHIELD
016-06 75-012-5 I.M.OtherAMA EDUCATION NUMBER
IL036053249Medicaid
IL01638042OtherBLUE CROSS/BLUE SHIELD
ILC44430Medicare UPIN