Provider Demographics
NPI:1245236363
Name:SCHUBERT, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:SCHUBERT
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 1:301 MADISON ST
Mailing Address - Street 2:SUITE 260
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435
Mailing Address - Country:US
Mailing Address - Phone:815-773-7807
Mailing Address - Fax:815-773-7874
Practice Address - Street 1:301 MADISON ST
Practice Address - Street 2:SUITE 260
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-773-7807
Practice Address - Fax:815-773-7874
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036082086207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036082086Medicaid
IL036082086Medicaid
IL110089271OtherRAILROAD MEDICARE
ILE87861Medicare UPIN
ILL33012Medicare ID - Type Unspecified