Provider Demographics
NPI:1013997345
Name:KIRSON, INBAR (MD)
Entity Type:Individual
Prefix:DR
First Name:INBAR
Middle Name:
Last Name:KIRSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SKOKIE BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2820
Mailing Address - Country:US
Mailing Address - Phone:847-562-1410
Mailing Address - Fax:847-562-0830
Practice Address - Street 1:601 SKOKIE BLVD STE 400
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2820
Practice Address - Country:US
Practice Address - Phone:847-562-1410
Practice Address - Fax:847-562-0830
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098294207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL748450OtherPROVIDER GROUP MEDICARE
ILH22216Medicare UPIN
ILK25778Medicare PIN