Provider Demographics
NPI:1326066929
Name:NOVEN, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:NOVEN
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 1:3023 N CLARK ST # 755
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5200
Mailing Address - Country:US
Mailing Address - Phone:773-635-0032
Mailing Address - Fax:312-281-8031
Practice Address - Street 1:180 N MICHIGAN AVE
Practice Address - Street 2:SUITE 1605
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-7401
Practice Address - Country:US
Practice Address - Phone:773-635-0032
Practice Address - Fax:773-289-0421
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-071522207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-071522Medicaid
ILL97482Medicare ID - Type Unspecified
IL036-071522Medicaid