Provider Demographics
NPI:1952587511
Name:ENT SPECIALISTS, LTD
Entity Type:Organization
Organization Name:ENT SPECIALISTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SCHUBKEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-495-6000
Mailing Address - Street 1:57 OGDEN AVE
Mailing Address - Street 2:
Mailing Address - City:CLARENDON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60514-1026
Mailing Address - Country:US
Mailing Address - Phone:630-495-6000
Mailing Address - Fax:630-495-6001
Practice Address - Street 1:57 OGDEN AVE
Practice Address - Street 2:
Practice Address - City:CLARENDON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60514-1026
Practice Address - Country:US
Practice Address - Phone:630-495-6000
Practice Address - Fax:630-495-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-084344174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL022-15697OtherBC/BS PROVIDER NUMBER
IL036084344Medicaid
ILCM3993OtherRAILROAD MEDICARE
IL022-15697OtherBC/BS PROVIDER NUMBER