Individual
ILYA M AVERBUCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 HEALTH CENTER DR, MATTOON, IL 61938
(217) 258-2440
(217) 258-2186
Mailing address
1005 HEALTH CENTER DR STE 201, MATTOON, IL 61938-4693
(217) 238-6055
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036-068971
IL
207L00000X
Anesthesiology Physician
MD032400E
PA
207LP2900X
Pain Medicine (Anesthesiology) Physician
MD032400E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001000711
—
PA
05
—
0265705
—
NJ
01
—
570900
MEDICARE NJ
NJ
Enumeration date
11/23/2005
Last updated
11/12/2018
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