Healthcare Provider Details

I. General information

NPI: 1053991174
Provider Name (Legal Business Name): ROBIN A RICE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2021
Last Update Date: 07/26/2022
Certification Date: 06/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 W HARRISON ST
CHICAGO IL
60612-3801
US

IV. Provider business mailing address

1313 W RANDOLPH ST APT 305
CHICAGO IL
60607-1516
US

V. Phone/Fax

Practice location:
  • Phone: 630-809-4003
  • Fax:
Mailing address:
  • Phone: 630-809-4004
  • Fax:

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 Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number125079840
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: