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NPI Code Detail

MEDICARE: DR. J. ROMAINE ROBERTS MD

MEDICARE: DR. J. ROMAINE 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
1207L00000XAnesthesiology PhysicianD59996MD
2207QG0300XGeriatric Medicine (Family Medicine) Physician036.073364IL
3207QG0300XGeriatric Medicine (Family Medicine) Physician0101233240IN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2J784-0001OTHERMDBC/BS

General Provider Information

NPI Number : 1376528802
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. J. ROMAINE ROBERTS MD
Provider Business Mailing Address
First Line : 1229 N NORTH BRANCH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2473
Country : US
Telephone Number : 312-445-5673
Fax Number : 312-284-4755
Provider Business Practice Location Address
First Line : 1229 N NORTH BRANCH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60642-2473
Country : US
Telephone Number : 312-445-5673
Fax Number : 312-284-4755
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 10/18/2010

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Directions to “ DR. J. ROMAINE ROBERTS MD” Practice Location

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