Active NPI
Michael C Loebach, MD
- Otolaryngology Physician
- Aurora, IL
National Provider Identifier
1366453755
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Otolaryngology Physician
- License
- 036-047494
- Practice address
- 1221 N Highland Ave
Aurora, IL 60506-1404 - Phone
- (630) 859-8700
- NPI assigned
- Aug 10, 2006
- Last updated
- Jun 28, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Otolaryngology Physician | 207Y00000X | 036-047494 | IL | Primary |
Addresses
Primary practice location
1221 N Highland Ave
Aurora, IL 60506-1404
Mailing address
1870 W Galena Blvd
Aurora, IL 60506-4356
Phone (630) 859-6700
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 036047494 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-047494 | IL | MD | Otolaryngology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155168000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1309219200000",
"number": "1366453755",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1870 W GALENA BLVD",
"city": "AURORA",
"state": "IL",
"postal_code": "605064356",
"telephone_number": "630-859-6700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1221 N HIGHLAND AVE",
"city": "AURORA",
"state": "IL",
"postal_code": "605061404",
"telephone_number": "630-859-8700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LOEBACH",
"first_name": "MICHAEL",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-10",
"last_updated": "2011-06-28",
"status": "A"
},
"taxonomies": [
{
"code": "207Y00000X",
"taxonomy_group": "",
"desc": "Otolaryngology",
"state": "IL",
"license": "036-047494",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036047494",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Aurora, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.