Provider Demographics
NPI:1689787889
Name:ROBINSON, CARL A (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:A
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:SUITE 106
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-1145
Mailing Address - Country:US
Mailing Address - Phone:708-799-3305
Mailing Address - Fax:708-799-8592
Practice Address - Street 1:17901 GOVERNORS HWY
Practice Address - Street 2:SUITE 208
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-1144
Practice Address - Country:US
Practice Address - Phone:708-799-3305
Practice Address - Fax:708-799-7220
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036116601207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN