Provider Demographics
NPI:1487702775
Name:HOBBS, JOHN (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HOBBS
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 1:736 W 95TH ST
Mailing Address - Street 2:HALSTED MEDICAL CENTER
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60628-1063
Mailing Address - Country:US
Mailing Address - Phone:773-487-7700
Mailing Address - Fax:708-229-6077
Practice Address - Street 1:736 W 95TH ST
Practice Address - Street 2:HALSTED MEDICAL CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-1063
Practice Address - Country:US
Practice Address - Phone:773-487-7700
Practice Address - Fax:708-229-6077
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036054680207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036054680Medicaid
IL363373816OtherTIN
IL741050Medicare ID - Type Unspecified
IL036054680Medicaid