Provider Demographics
NPI:1902913759
Name:AUERBACH, ALAN MARK (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:MARK
Last Name:AUERBACH
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 1:15 TOWER CT STE 210
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-3355
Mailing Address - Country:US
Mailing Address - Phone:847-508-1509
Mailing Address - Fax:847-625-6666
Practice Address - Street 1:15 TOWER CT STE 210
Practice Address - Street 2:
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-3355
Practice Address - Country:US
Practice Address - Phone:847-599-1444
Practice Address - Fax:847-599-1665
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01065184207RG0100X
IL036059072207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0031600714OtherBLUE CROSS/
IL036059072Medicaid
IN200904620Medicaid
IL0031600714OtherBLUE CROSS/
IN200904620Medicaid