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NPI Code Detail

MEDICARE: DR. ROBERT LARSON DO

MEDICARE: DR. ROBERT LARSON 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
1207R00000XInternal Medicine Physician036.179662IL

General Provider Information

NPI Number : 1902546963
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT LARSON DO
Provider Business Mailing Address
First Line : 7431 THOMAS DR
Second Line :
City : LOVES PARK
State : IL
Zip : 61111-5387
Country : US
Telephone Number : 815-519-6087
Fax Number :
Provider Business Practice Location Address
First Line : 5666 E STATE ST
Second Line :
City : ROCKFORD
State : IL
Zip : 61108-2425
Country : US
Telephone Number : 815-519-6087
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2022
Last Update Date : 04/29/2026

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