MEDICARE: DR. ROBERT CHARLES BEITER PH.D.

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	231H00000X	Audiologist		IL

General Provider Information

NPI Number	:	1467587980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT CHARLES BEITER PH.D.

Provider Business Mailing Address
First Line	:	6905 NORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1041
Country	:	US
Telephone Number	:	708-445-7171
Fax Number	:	708-445-2616

Provider Business Practice Location Address
First Line	:	6905 NORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-1041
Country	:	US
Telephone Number	:	708-445-7171
Fax Number	:	708-445-2616

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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