MEDICARE: DR. ROBERT ALLAN LIZER D.O.

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
1	207Q00000X	Family Medicine Physician	036094218	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184624280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALLAN LIZER D.O.

Provider Business Mailing Address
First Line	:	5401 N KNOXVILLE AVE
Second Line	:	SUITE 412
City	:	PEORIA
State	:	IL
Zip	:	61614-5098
Country	:	US
Telephone Number	:	309-692-4375
Fax Number	:	309-692-9820

Provider Business Practice Location Address
First Line	:	5401 N KNOXVILLE AVE
Second Line	:	SUITE 412
City	:	PEORIA
State	:	IL
Zip	:	61614-5098
Country	:	US
Telephone Number	:	309-692-4375
Fax Number	:	309-692-9820

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	04/17/2012

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