Healthcare Provider Details

I. General information

NPI: 1992995625
Provider Name (Legal Business Name): ROBERT T. EGEL, M. D., S. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2699
US

IV. Provider business mailing address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5445
  • Fax: 708-684-3112
Mailing address:
  • Phone: 708-684-5445
  • Fax: 708-684-3112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: DR. ROBERT TERRELL EGEL
Title or Position: PRESIDENT
Credential: M. D.
Phone: 708-684-5445