Provider Demographics
NPI:1356353270
Name:GERMBUSTERS, PC
Entity type:Organization
Organization Name:GERMBUSTERS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:TIBALLI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-741-4376
Mailing Address - Street 1:PO BOX 6079
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60121-6079
Mailing Address - Country:US
Mailing Address - Phone:847-741-4376
Mailing Address - Fax:847-741-5331
Practice Address - Street 1:2144 FOOTHILL RD
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5871
Practice Address - Country:US
Practice Address - Phone:847-741-4376
Practice Address - Fax:847-741-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036091388207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL206819Medicare ID - Type Unspecified
IL491540Medicare ID - Type Unspecified
IL491480Medicare ID - Type Unspecified