Provider Demographics
NPI:1033225222
Name:HOLSTEIN, ROBERT LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LOUIS
Last Name:HOLSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E HURON
Mailing Address - Street 2:SUITE 805
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2912
Mailing Address - Country:US
Mailing Address - Phone:312-649-6565
Mailing Address - Fax:312-649-9842
Practice Address - Street 1:150 E HURON
Practice Address - Street 2:SUITE 805
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2912
Practice Address - Country:US
Practice Address - Phone:312-649-6565
Practice Address - Fax:312-649-9842
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21605857OtherBLUE CROSS BLUE SHIELD
IL484581Medicare ID - Type Unspecified
IL21605857OtherBLUE CROSS BLUE SHIELD