MEDICARE: ROBERT BROCKMAN 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	208600000X	Surgery Physician		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4615036	OTHER	IL	BCBS PROVIDER ID

General Provider Information

NPI Number	:	1437115722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT BROCKMAN MD

Provider Business Mailing Address
First Line	:	777 OAKMONT LN
Second Line	:	SUITE 1600
City	:	WESTMONT
State	:	IL
Zip	:	60559-5511
Country	:	US
Telephone Number	:	630-789-2550
Fax Number	:

Provider Business Practice Location Address
First Line	:	375 N WALL ST
Second Line	:	SUITE P640
City	:	KANKAKEE
State	:	IL
Zip	:	60901-3483
Country	:	US
Telephone Number	:	815-932-0911
Fax Number	:

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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Directions to “ ROBERT BROCKMAN MD” Practice Location

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