Provider Demographics
NPI:1710038997
Name:FELDMAN, ROBERT R (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:FELDMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3163 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-1144
Mailing Address - Country:US
Mailing Address - Phone:847-601-3192
Mailing Address - Fax:
Practice Address - Street 1:3163 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-1144
Practice Address - Country:US
Practice Address - Phone:847-601-3192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-003643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001607224OtherBLUE CROSS BLUE SHIELD
IL071-003643OtherSTATE LICENSE
IL364311Medicare UPIN