MEDICARE: ROBINSON

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	252Y00000X	Early Intervention Provider Agency

General Provider Information

NPI Number	:	1730544925
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBINSON

Provider Business Mailing Address
First Line	:	3335 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3838
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3335 S INDIANA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3838
Country	:	US
Telephone Number	:	708-253-9271
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MONIQUE S ROBINSON
Credential	:	DT
Telephone Number	:	708-253-9271

Provider Enumeration Date	:	12/15/2015
Last Update Date	:	12/15/2015

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