Provider Demographics
NPI:1417970724
Name:BROGADIR, ROBERT K (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:BROGADIR
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 1:1306 MADISON DR
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-6826
Mailing Address - Country:US
Mailing Address - Phone:847-634-3348
Mailing Address - Fax:847-634-6882
Practice Address - Street 1:1306 MADISON DR
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-6826
Practice Address - Country:US
Practice Address - Phone:847-634-3348
Practice Address - Fax:847-634-6882
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL60001331OtherBLUE CROSS- BLUE SHIELD
IL700830Medicare ID - Type Unspecified
ILT37991Medicare UPIN