Provider Demographics
NPI:1053320473
Name:ZAGAR, ROBERT JOHN (PHD MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:ZAGAR
Suffix:
Gender:M
Credentials:PHD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E ERIE ST STE 404A
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5936
Mailing Address - Country:US
Mailing Address - Phone:312-266-3411
Mailing Address - Fax:312-266-3411
Practice Address - Street 1:233 E ERIE ST STE 404A
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-5936
Practice Address - Country:US
Practice Address - Phone:312-266-3411
Practice Address - Fax:312-266-3411
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0710039002084F0202X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21247Medicare UPIN
ILK19552Medicare UPIN