MEDICARE: ANN ELIZABETH 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	208D00000X	General Practice Physician	26442	KY
2	207Q00000X	Family Medicine Physician	KY26442	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	P00746838	OTHER	KY	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3722091000	OTHER	KY	PASSPORT ADVANTAGE
2	000000617689	OTHER	KY	ANTHEM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	50024361	OTHER	KY	PASSPORT

General Provider Information

NPI Number	:	1437145695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANN ELIZABETH ROBERTS 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	:	1230 MARKET ST
Second Line	:
City	:	LA GRANGE
State	:	KY
Zip	:	40031-7986
Country	:	US
Telephone Number	:	502-225-6900
Fax Number	:	502-666-7693

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	12/05/2018

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Directions to “ ANN ELIZABETH ROBERTS MD” Practice Location

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