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NPI Code Detail

MEDICARE: DR. ROBERT C PRENTICE D.O.

MEDICARE: DR. ROBERT C PRENTICE D.O.
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
1207RC0000XCardiovascular Disease Physician036067066IL
2207RI0011XInterventional Cardiology Physician036067066IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2236551OTHERILMEDICARE GROUP
3236550OTHERILMEDICARE GROUP
6060042297OTHERILRAILROAD MEDICARE COOK
7060056572OTHERILRAILROAD MEDICARE WILL
8CD8033OTHERILRAILROAD MEDICARE GROUP PTAN NUMBER
9CN2703OTHERILRAILROAD MEDICARE GROUP PTAN NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
401621208OTHERILBLUE CROSS BLUE SHIELD
51508810086OTHERILGROUP NPI

General Provider Information

NPI Number : 1194789354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT C PRENTICE D.O.
Provider Business Mailing Address
First Line : 13011 S 104TH AVE STE 100
Second Line :
City : PALOS PARK
State : IL
Zip : 60464-1508
Country : US
Telephone Number : 708-478-3600
Fax Number : 708-478-3552
Provider Business Practice Location Address
First Line : 13011 S 104TH AVE STE 100
Second Line :
City : PALOS PARK
State : IL
Zip : 60464-1508
Country : US
Telephone Number : 708-274-3278
Fax Number : 708-274-3299
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 12/15/2021

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1932163623 — DR. DOMINICK J STELLA M.D.
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1225092992 — DR. ROY C BLILEY M.D.
Practice Location Address:
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Practice Fax: 708-274-3299
1528022191 — DR. PETER W KAKAVAS M.D.
Practice Location Address:
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Practice Fax: 708-274-3299

Directions to “ DR. ROBERT C PRENTICE D.O.” Practice Location

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