Provider Demographics
NPI:1538185095
Name:HERSKOVIC, ARNOLD M (MD)
Entity type:Individual
Prefix:
First Name:ARNOLD
Middle Name:M
Last Name:HERSKOVIC
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 1:680 N LAKE SHORE DR
Mailing Address - Street 2:418
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-654-0051
Mailing Address - Fax:
Practice Address - Street 1:680 N LAKE SHORE DR
Practice Address - Street 2:418
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-4546
Practice Address - Country:US
Practice Address - Phone:312-654-0051
Practice Address - Fax:312-942-2894
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097303207Q00000X, 2085R0001X, 208D00000X
WI5146-3202085R0001X
MIEMC00063932085R0203X
IL036-0973032085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-097303Medicaid
ILK49657Medicare PIN
IL036-097303Medicaid
ILK49657Medicare PIN