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
State | License ID | Taxonomies |
---|---|---|
IL | 036068882 | 2085N0700X, 2085R0202X |
OH | 25000041 | 2085R0202X |
IN | 01060991A | 2085R0202X |
WI | 34114 | 2085R0202X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
IL | 036068882 | Other | BLUE SHIELD |
IL | 212545 | Other | GROUP PTAN |
IL | 036068882 | Medicaid | |
IL | 202926 | Other | GROUP PTAN |
IL | 202926020 | Medicare PIN | |
IL | K28069 | Medicare ID - Type Unspecified | NORTH SHORE PHYSICIANS GR |
IL | K06483 | Medicare ID - Type Unspecified | BUCKTOWN OPEN MRI |
IL | K02636 | Medicare ID - Type Unspecified | S.SUBURBAN OPEN MRI ORLAN |
IL | K27846 | Medicare ID - Type Unspecified | MERIDIAN- AREA 15 |
IL | 036068882 | Other | BLUE SHIELD |
IL | 202926 | Other | GROUP PTAN |
IL | 212545 | Other | GROUP PTAN |
IL | P00082045 | Medicare ID - Type Unspecified | RR MED- OLYMPIA FIELDS MR |
IL | K27860 | Medicare ID - Type Unspecified | MERIDIAN -AREA 99 |
IL | K28614 | Medicare ID - Type Unspecified | RAND IMAGING |
E40234 | Medicare UPIN | ||
IL | P00081846 | Medicare ID - Type Unspecified | RR MED. S.SUB OPEN MRI OR |
IL | 300122116 | Medicare ID - Type Unspecified | MED.RR-CORPORATE WOODS MR |
IL | K07037 | Medicare ID - Type Unspecified | PEORIA OPEN MRI |
IL | K05183 | Medicare ID - Type Unspecified | JOLIET OPEN MRI |
IL | K14422 | Medicare ID - Type Unspecified | TRI CITIES OPEN MRI |
IL | 212545028 | Medicare PIN | |
IL | K03540 | Medicare ID - Type Unspecified | OPEN MRI OLYMPIA FIELDS |