Provider Demographics
NPI:1710996962
Name:CHALLENGER, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:CHALLENGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:610 E ROOSEVELT RD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5574
Mailing Address - Country:US
Mailing Address - Phone:630-653-5550
Mailing Address - Fax:630-653-5561
Practice Address - Street 1:610 E ROOSEVELT RD
Practice Address - Street 2:SUITE 302
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-5574
Practice Address - Country:US
Practice Address - Phone:630-653-5550
Practice Address - Fax:630-653-5561
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-091376208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
212210023Medicare PIN
G98958Medicare UPIN
K20452Medicare PIN