Healthcare Provider Details

I. General information

NPI: 1558522805
Provider Name (Legal Business Name): ROBERT BRETT LLOYD JR. M.D./PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E WASHINGTON ST STE 2036
CHICAGO IL
60602-1818
US

IV. Provider business mailing address

25 E WASHINGTON ST STE 2036
CHICAGO IL
60602-1818
US

V. Phone/Fax

Practice location:
  • Phone: 404-954-0226
  • Fax: 916-313-2427
Mailing address:
  • Phone: 404-954-0226
  • Fax: 916-313-2427

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number036129661
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: