MEDICARE: DR. ROBERT ETHAN APPLEBAUM M.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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036074981	IL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	01035864A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	01618941	OTHER	IL	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477553188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ETHAN APPLEBAUM M.D.

Provider Business Mailing Address
First Line	:	2310 YORK ST STE 3A
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:	708-986-4675
Fax Number	:	773-341-2933

Provider Business Practice Location Address
First Line	:	2310 YORK ST STE 3A
Second Line	:
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:	708-986-4675
Fax Number	:	773-341-2933

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

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	02/06/2026

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