Provider Demographics
NPI:1861445256
Name:STRUGALA, ROBERT J (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:STRUGALA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2850 S WABASH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-2955
Mailing Address - Country:US
Mailing Address - Phone:312-842-4600
Mailing Address - Fax:312-846-8694
Practice Address - Street 1:2850 S WABASH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-2955
Practice Address - Country:US
Practice Address - Phone:312-842-4600
Practice Address - Fax:312-846-8694
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0361031672083S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036103167Medicaid
IL036103167Medicaid