Provider Demographics
NPI:1922312198
Name:NABHER HEALTHCARE, P.C.
Entity Type:Organization
Organization Name:NABHER HEALTHCARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-827-4496
Mailing Address - Street 1:1792 E. OAKTON STREET
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-2110
Mailing Address - Country:US
Mailing Address - Phone:847-827-4496
Mailing Address - Fax:847-827-1256
Practice Address - Street 1:1792 E. OAKTON STREET
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-2110
Practice Address - Country:US
Practice Address - Phone:847-827-4496
Practice Address - Fax:847-827-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036108886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207Q00000XOtherPROVIDER TAXONOMY
IL036108886Medicaid
IL036108886Medicaid
ILR02471 ICCMedicare PIN
ILK53669 EP & DPMedicare PIN