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NPI Code Detail

MEDICARE: JOHN ROBERT SOUTER III MD

MEDICARE: JOHN ROBERT SOUTER III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207T00000XNeurological Surgery PhysicianME179701FL

General Provider Information

NPI Number : 1144789157
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN ROBERT SOUTER III MD
Provider Business Mailing Address
First Line : 1740 W TAYLOR ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-7232
Country : US
Telephone Number : 312-996-4842
Fax Number :
Provider Business Practice Location Address
First Line : 1740 W TAYLOR ST
Second Line :
City : CHICAGO
State : IL
Zip : 60612-7232
Country : US
Telephone Number : 312-996-4842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2019
Last Update Date : 03/19/2026

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