MEDICARE: ROBERT J. POOLEY JR. M.D.

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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036094979	IL

General Provider Information

NPI Number	:	1538169438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J. POOLEY JR. M.D.

Provider Business Mailing Address
First Line	:	2800 W 95TH ST
Second Line	:	DEPT. OF PATHOLOGY
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2701
Country	:	US
Telephone Number	:	708-229-5817
Fax Number	:	708-499-2337

Provider Business Practice Location Address
First Line	:	2800 W 95TH ST
Second Line	:	DEPT. OF PATHOLOGY
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-2701
Country	:	US
Telephone Number	:	708-229-5817
Fax Number	:	708-499-2337

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	12/07/2010

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