Healthcare Provider Details

I. General information

NPI: 1629418132
Provider Name (Legal Business Name): ROBERT W. BURTON, MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 TOWER RD
WINNETKA IL
60093-1638
US

IV. Provider business mailing address

1274 TOWER RD
WINNETKA IL
60093-1638
US

V. Phone/Fax

Practice location:
  • Phone: 312-203-3253
  • Fax: 847-595-8353
Mailing address:
  • Phone: 312-203-3253
  • Fax: 847-595-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number036072613
License Number StateIL

VIII. Authorized Official

Name: ROBERT W. BURTON
Title or Position: PRESIDENT
Credential: MD
Phone: 312-203-3253