Provider Demographics
NPI:1326068677
Name:GELLER, ROBERT HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HOWARD
Last Name:GELLER
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 1:1200 S YORK ST STE 4240
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-5651
Mailing Address - Country:US
Mailing Address - Phone:708-450-0462
Mailing Address - Fax:708-632-5602
Practice Address - Street 1:1200 S YORK ST STE 4240
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-5651
Practice Address - Country:US
Practice Address - Phone:708-450-0462
Practice Address - Fax:708-450-1591
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055119174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055119Medicaid
ILD14584Medicare UPIN