Provider Demographics
NPI:1669481180
Name:MACNAB, ROBERT KENNETH (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:MACNAB
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:330 MADISON ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60435-6565
Mailing Address - Country:US
Mailing Address - Phone:815-725-8400
Mailing Address - Fax:815-725-8401
Practice Address - Street 1:330 NORTH MADISON STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435
Practice Address - Country:US
Practice Address - Phone:815-725-8400
Practice Address - Fax:815-725-8401
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004436213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL020484OtherHEALTH ALLIANCE
IL0739010005OtherMEDICARE NSC
IL3200053OtherBCBS
ILCL7476OtherRAILROAD MEDICARE GROUP #
IL016004436Medicaid
IL0739010001OtherMEDICARE NSC
IL0739010006OtherMEDICARE NSC
IL0739010008OtherMEDICARE NSC
IL480032274OtherRR MEDICARE
IL0739010006OtherMEDICARE NSC
ILK06082Medicare PIN
ILCL7476OtherRAILROAD MEDICARE GROUP #
IL020484OtherHEALTH ALLIANCE
IL0739010008OtherMEDICARE NSC
IL0739010011Medicare NSC
IL627090Medicare PIN