MEDICARE: DR. ROBERT C KISPERT 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	106H00000X	Marriage & Family Therapist	166.000661	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	166-000661	OTHER	IL	MARRIAGE AND FAMILY THERA
2	35-000718A	OTHER	IN	MARRIAGE AND FAMILY THERA

General Provider Information

NPI Number	:	1679542559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT C KISPERT PH.D

Provider Business Mailing Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1514
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-629-1907
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 N MICHIGAN AVE
Second Line	:	SUITE 1514
City	:	CHICAGO
State	:	IL
Zip	:	60602-3402
Country	:	US
Telephone Number	:	312-629-1907
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/14/2012

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