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NPI Code Detail

MEDICARE: ROBERT T SPARROW MD

MEDICARE: ROBERT T SPARROW MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0005XHypertension Specialist Physician036062055IL
2207RN0300XNephrology Physician036062055IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390001121OTHERILRAILROAD MEDICARE

General Provider Information

NPI Number : 1134259781
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT T SPARROW MD
Provider Business Mailing Address
First Line : 420 NE GLEN OAK AVE STE 401
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-676-8123
Fax Number : 309-676-8455
Provider Business Practice Location Address
First Line : 420 NE GLEN OAK AVE STE 401
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-676-8123
Fax Number : 309-676-8455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 01/16/2025

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Directions to “ ROBERT T SPARROW MD” Practice Location

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