Healthcare Provider Details

I. General information

NPI: 1790719466
Provider Name (Legal Business Name): ROBERT GORDON KALB MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/16/2022
Certification Date: 02/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 E ERIE ST STE 1900
CHICAGO IL
60611-3246
US

IV. Provider business mailing address

259 E ERIE ST STE 1900
CHICAGO IL
60611-3246
US

V. Phone/Fax

Practice location:
  • Phone: 312-695-7950
  • Fax: 312-695-5747
Mailing address:
  • Phone: 312-695-7950
  • Fax: 312-695-5747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036144751
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD418931
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number036144751
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: