Provider Demographics
NPI:1275538811
Name:MIKLOS, ROBERT C (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:MIKLOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6634 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2408
Mailing Address - Country:US
Mailing Address - Phone:773-586-5487
Mailing Address - Fax:773-586-9523
Practice Address - Street 1:6634 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2408
Practice Address - Country:US
Practice Address - Phone:773-586-5487
Practice Address - Fax:773-586-9523
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003168213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003168Medicaid
ILT37495Medicare UPIN
IL016003168Medicaid