Provider Demographics
NPI:1437211562
Name:RALEY, ROBERT ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:RALEY
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 1:70 MEADOWVIEW CTR
Mailing Address - Street 2:SUITE 401
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-2047
Mailing Address - Country:US
Mailing Address - Phone:815-932-1724
Mailing Address - Fax:815-932-1729
Practice Address - Street 1:70 MEADOWVIEW CTR
Practice Address - Street 2:SUITE 401
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2047
Practice Address - Country:US
Practice Address - Phone:815-932-1724
Practice Address - Fax:815-932-1729
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016003683213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016003683Medicaid
ILT38416Medicare UPIN
IL016003683Medicaid