Provider Demographics
NPI:1649301334
Name:DIABETES OSTEOPOROSIS THYROID ENDOCRINE CENTER LLC
Entity type:Organization
Organization Name:DIABETES OSTEOPOROSIS THYROID ENDOCRINE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:RABINOWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-662-9500
Mailing Address - Street 1:4077 LIGHTHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3113
Mailing Address - Country:US
Mailing Address - Phone:847-662-9500
Mailing Address - Fax:847-662-9551
Practice Address - Street 1:1425 N HUNT CLUB RD STE 303
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2639
Practice Address - Country:US
Practice Address - Phone:847-662-9500
Practice Address - Fax:847-662-9551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036085078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI000052024Medicare PIN
IL204143Medicare PIN