Provider Demographics
NPI:1093719908
Name:HART, ROBERT JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JAY
Last Name:HART
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 1:19815 GOVERNORS HWY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-4385
Mailing Address - Country:US
Mailing Address - Phone:708-798-2950
Mailing Address - Fax:708-957-7471
Practice Address - Street 1:19815 GOVERNORS HWY
Practice Address - Street 2:SUITE 2
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-4385
Practice Address - Country:US
Practice Address - Phone:708-798-2950
Practice Address - Fax:708-957-7471
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2007-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036042512207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
491600Medicare ID - Type Unspecified
D13115Medicare UPIN