Provider Demographics
NPI:1871509323
Name:LOWENTHAL, ROBERT ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALLEN
Last Name:LOWENTHAL
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 1:1025 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62703-2403
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:217-528-8962
Practice Address - Street 1:1025 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-2403
Practice Address - Country:US
Practice Address - Phone:217-528-7541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036099681207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL317403OtherPERSONAL CARE
IL036099681OtherIL STATE LICENSE
ILDE7074OtherRR MEDICARE GROUP#
IL117373OtherHEALTH ALLIANCE
IL08432151OtherBC/BS
IL036099681Medicaid
ILK27401Medicare PIN
IL398776OtherHEALTHLINK
ILP00310636OtherRR MEDICARE PIN
ILG04458Medicare UPIN
IL204302401OtherTAX ID
IL611236600OtherACS
IL213531Medicare ID - Type UnspecifiedMEDICARE LOC 99 GROUP#
IL213530Medicare ID - Type UnspecifiedMEDICARE LOC 12 GROUP#
ILK27404Medicare PIN