Provider Demographics
NPI:1558475590
Name:EINHORN, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:EINHORN
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 N EAST ST
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-2499
Mailing Address - Country:US
Mailing Address - Phone:618-395-5222
Mailing Address - Fax:618-395-8552
Practice Address - Street 1:1200 N EAST ST
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-2499
Practice Address - Country:US
Practice Address - Phone:618-395-5222
Practice Address - Fax:618-395-8552
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036057099208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
370004317OtherRAILROAD MEDICARE
IL036057099Medicaid
IL122138OtherHEALTHLINK
IL062288OtherHEALTH ALLIANCE
ILC37424Medicare UPIN
370004317OtherRAILROAD MEDICARE