Healthcare Provider Details

I. General information

NPI: 1255348546
Provider Name (Legal Business Name): ROBIN S BIERMANN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 06/29/2021
Certification Date: 06/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MONTVALE DR STE A
SPRINGFIELD IL
62704-6924
US

IV. Provider business mailing address

2040 W ILES AVE SUITE C
SPRINGFIELD IL
62704-4662
US

V. Phone/Fax

Practice location:
  • Phone: 217-726-8096
  • Fax:
Mailing address:
  • Phone: 217-789-7743
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number036086052
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number036086052
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number036086052
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number036086052
License Number StateIL
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036086052
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2012012824
License Number StateMO
# 7
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number036086052
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number036086052
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: