Healthcare Provider Details

I. General information

NPI: 1982655395
Provider Name (Legal Business Name): ROBERT J. CITRONBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/07/2023
Certification Date: 07/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 95TH ST
OAK LAWN IL
60453-2654
US

IV. Provider business mailing address

29373 NETWORK PL
CHICAGO IL
60673-1288
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-1840
  • Fax: 708-684-1841
Mailing address:
  • Phone: 847-390-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036082803
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: