Provider Demographics
NPI:1114923877
Name:SCHENCK, ROBERT ROY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROY
Last Name:SCHENCK
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 1:1100 N LAKE SHORE DR
Mailing Address - Street 2:APT 33A
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-5207
Mailing Address - Country:US
Mailing Address - Phone:312-266-7346
Mailing Address - Fax:312-738-2954
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:STE 319
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-738-3426
Practice Address - Fax:312-738-2954
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL3634338174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD12394Medicare UPIN
ILL35589Medicare ID - Type Unspecified