Provider Demographics
NPI:1588693626
Name:KOBLER, WILLIAM ERIC (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ERIC
Last Name:KOBLER
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 1:6830 VILLAGREEN VW
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-5639
Mailing Address - Country:US
Mailing Address - Phone:815-282-1339
Mailing Address - Fax:815-282-1298
Practice Address - Street 1:6830 VILLAGREEN VW
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-5639
Practice Address - Country:US
Practice Address - Phone:815-282-1339
Practice Address - Fax:815-282-1298
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051442207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036051442Medicaid
ILL57216Medicare ID - Type Unspecified
IL080047787Medicare ID - Type UnspecifiedRR INDIVIDUAL #
ILC37285Medicare UPIN
IL846930Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILCC5050Medicare ID - Type UnspecifiedRR GROUP #