Healthcare Provider Details

I. General information

NPI: 1962591404
Provider Name (Legal Business Name): ROBERT TODD HARGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3245 N HALSTED ST
CHICAGO IL
60657-3419
US

IV. Provider business mailing address

3245 N HALSTED ST STE 500
CHICAGO IL
60657-3419
US

V. Phone/Fax

Practice location:
  • Phone: 773-388-1600
  • Fax:
Mailing address:
  • Phone: 773-388-1600
  • Fax: 773-296-1097

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0360941631
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: