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General NPI Number Information
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NPI Number | 1912974684
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Entity Type | Individual
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Provider Name | BRUCE ROBERTS MD
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Gender | Male
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Dates
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Enumeration Date | 03/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 275 POPLAR RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4346
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Country | US
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Telephone | 312-404-4261
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Fax | 708-202-2085
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Provider Business Mailing Address
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Address Line | 275 POPLAR RD
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-4346
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Country | US
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Telephone | 312-404-4261
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Fax | 708-202-2085
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 36057770
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License Number State | IL
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