MEDICARE: VIOLET ROBERSON DO

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	207Q00000X	Family Medicine Physician	036114499	IL
2	2083X0100X	Occupational Medicine Physician	036114499	IL
3	207Q00000X	Family Medicine Physician	54043	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ROBERANN	OTHER	WI	MERCYCARE INSURANCE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578536207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIOLET ROBERSON DO

Provider Business Mailing Address
First Line	:	3344 W PETERSON AVE
Second Line	:	STE 101
City	:	CHICAGO
State	:	IL
Zip	:	60659-3531
Country	:	US
Telephone Number	:	773-245-3222
Fax Number	:	773-796-5250

Provider Business Practice Location Address
First Line	:	1215 N ALPINE RD
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61107-2201
Country	:	US
Telephone Number	:	815-391-7800
Fax Number	:

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

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	02/25/2016

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Directions to “ VIOLET ROBERSON DO” Practice Location

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