Healthcare Provider Details

I. General information

NPI: 1326068677
Provider Name (Legal Business Name): ROBERT HOWARD GELLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2006
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S YORK ST STE 4240
ELMHURST IL
60126-5651
US

IV. Provider business mailing address

1200 S YORK ST STE 4240
ELMHURST IL
60126-5651
US

V. Phone/Fax

Practice location:
  • Phone: 708-450-0462
  • Fax: 708-450-1591
Mailing address:
  • Phone: 708-450-0462
  • Fax: 708-632-5602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number036055119
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: