Provider Demographics
NPI:1669413811
Name:ALSPACH, DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:ALSPACH
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 1:2650 RIDGE AVE
Mailing Address - Street 2:ANESTHESIOLOGY ROOM 3905
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1718
Mailing Address - Country:US
Mailing Address - Phone:847-570-2760
Mailing Address - Fax:847-507-2921
Practice Address - Street 1:2650 RIDGE AVE
Practice Address - Street 2:ANESTHESIOLOGY ROOM 3905
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1718
Practice Address - Country:US
Practice Address - Phone:847-570-2760
Practice Address - Fax:847-507-2921
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036104556207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623422OtherBLUE SHIELD
IL050088467OtherRAILROAD MEDICARE
IL036104556Medicaid
ILH68283Medicare UPIN
IL036104556Medicaid
ILL92992Medicare PIN