Provider Demographics
NPI:1891922886
Name:MACUMBER, IAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:ROBERT
Last Name:MACUMBER
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 1:607 W WRIGHTWOOD AVE
Mailing Address - Street 2:APT 215
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-2542
Mailing Address - Country:US
Mailing Address - Phone:978-846-1443
Mailing Address - Fax:
Practice Address - Street 1:1653 W CONGRESS PARKWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612
Practice Address - Country:US
Practice Address - Phone:978-846-1443
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-056527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics