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General NPI Number Information
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NPI Number | 1548525231
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Entity Type | Individual
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Provider Name | DR. DAVID ROBERTSON
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Gender | Male
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Dates
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Enumeration Date | 07/09/2012
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 26856 S 88TH AVE
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City | MONEE
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State | IL
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Zip | 60449-9532
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Country | US
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Telephone | 708-829-0865
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Fax | 708-534-8753
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Provider Business Mailing Address
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Address Line | 26856 S 88TH AVE
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City | MONEE
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State | IL
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Zip | 60449-9532
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Country | US
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Telephone | 708-829-0865
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Fax | 708-534-8753
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 336014096
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 336.014096
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License Number State | IL
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