Healthcare Provider Details

I. General information

NPI: 1003062514
Provider Name (Legal Business Name): DAVID WILLIAM ROBERTS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 GROSS POINT RD SUITE 2900
SKOKIE IL
60076-1214
US

IV. Provider business mailing address

9650 GROSS POINT RD SUITE 2900
SKOKIE IL
60076-1214
US

V. Phone/Fax

Practice location:
  • Phone: 847-866-7846
  • Fax: 224-251-2905
Mailing address:
  • Phone: 847-866-7846
  • Fax: 224-251-2905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number125052813
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: