Provider Demographics
NPI:1790190221
Name:NEEDLEMAN, ROBERT KENNEY (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNEY
Last Name:NEEDLEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 W VAN BUREN ST APT 817
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-3597
Mailing Address - Country:US
Mailing Address - Phone:207-712-4072
Mailing Address - Fax:
Practice Address - Street 1:933 W VAN BUREN ST APT 817
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60607-3597
Practice Address - Country:US
Practice Address - Phone:207-712-4072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01079910A207P00000X
IL036146263207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine