MEDICARE: DR. NATHAN L ROBERTS 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
1	207Q00000X	Family Medicine Physician	036104517	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	:	1225089626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN L ROBERTS MD

Provider Business Mailing Address
First Line	:	101 W UNIVERSITY AVE
Second Line	:
City	:	CHAMPAIGN
State	:	IL
Zip	:	61820-3909
Country	:	US
Telephone Number	:	217-253-9258
Fax Number	:	217-253-9318

Provider Business Practice Location Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	TUSCOLA
State	:	IL
Zip	:	61953-1406
Country	:	US
Telephone Number	:	217-253-9258
Fax Number	:	217-253-9318

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	01/06/2022

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