Provider Demographics
NPI:1558526566
Name:SAKULANDA, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:SAKULANDA
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 1:2115 RIVER FALLS DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5122
Mailing Address - Country:US
Mailing Address - Phone:317-414-9712
Mailing Address - Fax:
Practice Address - Street 1:5306 N CUMBERLAND AVE
Practice Address - Street 2:APT. 214
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60656-1464
Practice Address - Country:US
Practice Address - Phone:773-628-7336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61649207Q00000X
IL036.119229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine