Provider Demographics
NPI:1922080399
Name:BREIT, ROBERT AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:AARON
Last Name:BREIT
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 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE G-18
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-918-1462
Mailing Address - Fax:847-968-4311
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE G-18
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-918-1462
Practice Address - Fax:847-968-4311
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360688822085N0700X, 2085R0202X
OH250000412085R0202X
IN01060991A2085R0202X
WI341142085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068882OtherBLUE SHIELD
IL212545OtherGROUP PTAN
IL036068882Medicaid
IL202926OtherGROUP PTAN
IL202926020Medicare PIN
ILK28069Medicare ID - Type UnspecifiedNORTH SHORE PHYSICIANS GR
ILK06483Medicare ID - Type UnspecifiedBUCKTOWN OPEN MRI
ILK02636Medicare ID - Type UnspecifiedS.SUBURBAN OPEN MRI ORLAN
ILK27846Medicare ID - Type UnspecifiedMERIDIAN- AREA 15
IL036068882OtherBLUE SHIELD
IL202926OtherGROUP PTAN
IL212545OtherGROUP PTAN
ILP00082045Medicare ID - Type UnspecifiedRR MED- OLYMPIA FIELDS MR
ILK27860Medicare ID - Type UnspecifiedMERIDIAN -AREA 99
ILK28614Medicare ID - Type UnspecifiedRAND IMAGING
E40234Medicare UPIN
ILP00081846Medicare ID - Type UnspecifiedRR MED. S.SUB OPEN MRI OR
IL300122116Medicare ID - Type UnspecifiedMED.RR-CORPORATE WOODS MR
ILK07037Medicare ID - Type UnspecifiedPEORIA OPEN MRI
ILK05183Medicare ID - Type UnspecifiedJOLIET OPEN MRI
ILK14422Medicare ID - Type UnspecifiedTRI CITIES OPEN MRI
IL212545028Medicare PIN
ILK03540Medicare ID - Type UnspecifiedOPEN MRI OLYMPIA FIELDS