NPIMap

Organization Active NPI

Ibsen, LLC

  • Clinic/Center
  • Crest Hill, IL
National Provider Identifier
1760873517
Registry record updated Feb 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
036057264 Issued in IL
Legal business name
IBSEN, LLC
Practice address
16003 Executive Dr
Crest Hill, IL 60403-0500
Phone
(815) 838-9544
Fax
(815) 838-9580
NPI assigned
Feb 16, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2015

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Rafael Perez Guerra, MDNPI 1578653994
Title
President
Phone
(815) 838-9544

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 036057264 IL Primary

Addresses

Primary practice location

16003 Executive Dr
Crest Hill, IL 60403-0500

Mailing address

16003 Executive Dr
Crest Hill, IL 60403-0500
Phone (815) 838-9544

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1424044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1424044800000",
    "number": "1760873517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16003 EXECUTIVE DR",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604030500",
            "telephone_number": "815-838-9544",
            "fax_number": "815-838-9580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16003 EXECUTIVE DR",
            "city": "CREST HILL",
            "state": "IL",
            "postal_code": "604030500",
            "telephone_number": "815-838-9544",
            "fax_number": "815-838-9580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IBSEN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-16",
        "last_updated": "2015-02-16",
        "status": "A",
        "authorized_official_last_name": "PEREZ GUERRA",
        "authorized_official_first_name": "RAFAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-838-9544",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": "036057264",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crest Hill, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.