Healthcare Provider Details

I. General information

NPI: 1669685905
Provider Name (Legal Business Name): ROBERT STEPHEN GREENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 E CHICAGO AVE # 55
CHICAGO IL
60611-2991
US

IV. Provider business mailing address

225 E CHICAGO AVE # 55
CHICAGO IL
60611-2991
US

V. Phone/Fax

Practice location:
  • Phone: 312-227-4000
  • Fax: 312-227-9525
Mailing address:
  • Phone: 312-227-4000
  • Fax: 312-227-9525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036117373
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: