Provider Demographics
NPI:1780677211
Name:HAVEY, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:HAVEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:259 E ERIE ST
Mailing Address - Street 2:SUITE 2350
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2987
Mailing Address - Country:US
Mailing Address - Phone:312-926-6000
Mailing Address - Fax:312-926-5971
Practice Address - Street 1:259 E ERIE ST
Practice Address - Street 2:SUITE 2350
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2987
Practice Address - Country:US
Practice Address - Phone:312-926-6000
Practice Address - Fax:312-926-5971
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2016-04-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036062559207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036062559Medicaid
IL110071279OtherRR MEDICARE
C44016Medicare UPIN
IL036062559Medicaid