MEDICARE: ROBERT L NEEMS DDS PC

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	122300000X	Dentist	019019466	IL

General Provider Information

NPI Number	:	1861887036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L NEEMS DDS PC

Provider Business Mailing Address
First Line	:	1945 W WILSON AVE
Second Line	:	SUITE 5117
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-588-7840
Fax Number	:	773-588-0711

Provider Business Practice Location Address
First Line	:	1945 W WILSON AVE
Second Line	:	SUITE 5117
City	:	CHICAGO
State	:	IL
Zip	:	60640-5255
Country	:	US
Telephone Number	:	773-588-7840
Fax Number	:	773-588-0711

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT L NEEMS
Credential	:	DDS
Telephone Number	:	773-588-7840

Provider Enumeration Date	:	04/03/2015
Last Update Date	:	04/03/2015

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