Provider Demographics
NPI:1063474633
Name:GERBER, ROBERT MARTIN (DPM)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:GERBER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 AUSTIN ST STE 469E
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60202-3455
Mailing Address - Country:US
Mailing Address - Phone:847-332-1112
Mailing Address - Fax:847-332-1114
Practice Address - Street 1:800 AUSTIN ST STE 469E
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-3455
Practice Address - Country:US
Practice Address - Phone:847-332-1112
Practice Address - Fax:847-332-1114
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003563213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001344OtherBLUE CROSS BLUE SHIELD
IL016003563Medicaid
711760Medicare ID - Type Unspecified