MEDICARE: DAVID ROBERTSON 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	2084N0400X	Neurology Physician	01065212A	IN
2	2084N0400X	Neurology Physician	48322	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	48322	OTHER	KY	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326195215
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ROBERTSON MD

Provider Business Mailing Address
First Line	:	PO BOX 776351
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-6351
Country	:	US
Telephone Number	:	502-588-9490
Fax Number	:	502-272-5116

Provider Business Practice Location Address
First Line	:	3991 DUTCHMANS LN STE 310
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40207-4716
Country	:	US
Telephone Number	:	502-899-6782
Fax Number	:	502-899-6783

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	08/07/2024

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Directions to “ DAVID ROBERTSON MD” Practice Location

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