Healthcare Provider Details

I. General information

NPI: 1033105093
Provider Name (Legal Business Name): ROBERT R RICHARDSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2005
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 DELNOR
GENEVA IL
60134
US

IV. Provider business mailing address

25 N WINFIELD RD
WINFIELD IL
60190-1295
US

V. Phone/Fax

Practice location:
  • Phone: 630-933-4056
  • Fax: 630-933-4057
Mailing address:
  • Phone: 630-933-4056
  • Fax: 630-933-4057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number036-044156
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: