Provider Demographics
NPI:1558603985
Name:STAUDINGER, ROBIN MARY
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MARY
Last Name:STAUDINGER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 SOUTH WOOD ST
Mailing Address - Street 2:RM. 440, MC 718
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-7323
Mailing Address - Country:US
Mailing Address - Phone:312-996-7836
Mailing Address - Fax:
Practice Address - Street 1:1415 TULANE AVE FL 6
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5110
Practice Address - Fax:504-988-0644
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA301616207RG0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology