Provider Demographics
NPI:1083682454
Name:LISTERNICK, ROBERT HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HOWARD
Last Name:LISTERNICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 CHILDRENS PLAZA
Mailing Address - Street 2:BOX 16 DIVISION OF GENERAL ACADEMIC PEDIATRICS
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614
Mailing Address - Country:US
Mailing Address - Phone:773-880-3832
Mailing Address - Fax:773-281-4237
Practice Address - Street 1:2300 CHILDRENS PLAZA
Practice Address - Street 2:DIVISION OF GENERAL ACADEMIC PEDIATRICS CHILDRENS MEMOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614
Practice Address - Country:US
Practice Address - Phone:773-880-3832
Practice Address - Fax:773-281-4237
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2011-09-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036062085208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062085Medicaid
C47373Medicare UPIN
IL036062085Medicaid