Provider Demographics
NPI:1972517803
Name:OTOLARYNGOLOGY GROUP LTD
Entity Type:Organization
Organization Name:OTOLARYNGOLOGY GROUP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCHONBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-729-9122
Mailing Address - Street 1:3633 W LAKE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026-5805
Mailing Address - Country:US
Mailing Address - Phone:847-729-9122
Mailing Address - Fax:847-729-9134
Practice Address - Street 1:3633 W LAKE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60026-5805
Practice Address - Country:US
Practice Address - Phone:847-729-9122
Practice Address - Fax:847-729-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01615422OtherBCBS
IL01615422OtherBCBS