Provider Demographics
NPI:1023063237
Name:GARB, JEFFREY LOUIS (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:LOUIS
Last Name:GARB
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 1:1710 N. RANDALL RD.
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123
Mailing Address - Country:US
Mailing Address - Phone:847-888-1914
Mailing Address - Fax:847-888-1925
Practice Address - Street 1:1710 N. RANDALL RD.
Practice Address - Street 2:SUITE 250
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123
Practice Address - Country:US
Practice Address - Phone:847-888-1914
Practice Address - Fax:847-888-1925
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-059113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059113Medicaid
IL036059113Medicaid
ILC41350Medicare UPIN
IL214169Medicare PIN