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NPI Code Detail

MEDICARE: ERIC D ROBERTS ARNP

MEDICARE: ERIC D ROBERTS ARNP
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
1363L00000XNurse Practitioner209.013365IL

General Provider Information

NPI Number : 1669554465
Entity Type Code : Individual
Provider Name (Legal Business Name) : ERIC D ROBERTS ARNP
Provider Business Mailing Address
First Line : 1512 EUCLID AVE
Second Line :
City : BERWYN
State : IL
Zip : 60402-1329
Country : US
Telephone Number : 816-217-9916
Fax Number :
Provider Business Practice Location Address
First Line : 932 LAKE ST
Second Line :
City : OAK PARK
State : IL
Zip : 60301-1204
Country : US
Telephone Number : 331-221-1700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 01/06/2022

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