Provider Demographics
NPI:1043274145
Name:IAFFALDANO, ROBERT A (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:IAFFALDANO
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 1:13011 S 104TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PALOS PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60464-1508
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:13011 S 104TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PALOS PARK
Practice Address - State:IL
Practice Address - Zip Code:60464-1508
Practice Address - Country:US
Practice Address - Phone:708-274-3278
Practice Address - Fax:708-274-3299
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081021207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL416810OtherMEDICARE GROUP
IL01621208OtherBLUECROSS BLUE SHIELD
IL236550OtherMEDICARE GROUP
IL036081021Medicaid
IL060042337OtherRAILROAD MEDICARE COOK
IL236551OtherMEDICARE GROUP
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILP00265015OtherRAILROAD MEDICARE KANKAKE
IL060043542OtherRAILROAD MEDICARE WILL
IL1508810086OtherGROUP NPI
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCN2703OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL236550OtherMEDICARE GROUP
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
F88049Medicare UPIN
IL036081021Medicaid