Provider Demographics
NPI:1093839433
Name:DR. ROBERT E. PULS, P.C.
Entity Type:Organization
Organization Name:DR. ROBERT E. PULS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:PULS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:815-463-8805
Mailing Address - Street 1:1352 N CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1163
Mailing Address - Country:US
Mailing Address - Phone:815-463-8805
Mailing Address - Fax:815-463-8806
Practice Address - Street 1:1352 N CEDAR RD
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1163
Practice Address - Country:US
Practice Address - Phone:815-463-8805
Practice Address - Fax:815-463-8806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1992850044OtherPERSONAL NPI