Healthcare Provider Details

I. General information

NPI: 1386487064
Provider Name (Legal Business Name): DOMINIC ANDRE JEAN ROBOLINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

IV. Provider business mailing address

3249 OAK PARK AVE
BERWYN IL
60402-3429
US

V. Phone/Fax

Practice location:
  • Phone: 708-783-2000
  • Fax: 708-783-3656
Mailing address:
  • Phone: 708-783-2000
  • Fax: 708-783-3656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number125-084458
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: