Provider Demographics
NPI:1871625483
Name:ALAN AUERBACH MD
Entity type:Organization
Organization Name:ALAN AUERBACH MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:AUERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-459-3345
Mailing Address - Street 1:125 E LAKE COOK RD
Mailing Address - Street 2:STE 229
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-4356
Mailing Address - Country:US
Mailing Address - Phone:847-459-3345
Mailing Address - Fax:847-459-3817
Practice Address - Street 1:125 E LAKE COOK RD
Practice Address - Street 2:STE 229
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-4356
Practice Address - Country:US
Practice Address - Phone:847-459-3345
Practice Address - Fax:847-459-3817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031600714Medicaid
IL0031600714Medicaid
ILB15273Medicare UPIN