Healthcare Provider Details

I. General information

NPI: 1821084120
Provider Name (Legal Business Name): ROBERT M FLIEGELMAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 CICERO AVE
CRESTWOOD IL
60445-1824
US

IV. Provider business mailing address

901 MCCLINTOCK DR SUITE 202
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 888-220-6432
  • Fax: 630-654-4253
Mailing address:
  • Phone: 888-220-6432
  • Fax: 630-654-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-061290
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: