Individual
THEODORE T. FABER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2045 W GRAND AVE, CHICAGO, IL 60612-1576
(086) 301-5347
Mailing address
2045 W GRAND AVE STE B, CHICAGO, IL 60612-1577
(708) 630-1534
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
14276
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
142768
—
SC
01
—
E137269482
MEDICARE PTAN
SC
Enumeration date
08/11/2006
Last updated
09/08/2022
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