Provider Demographics
NPI:1942286984
Name:GASIOR, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GASIOR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:11560 S KEDZIE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERRIONETTE PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60803-4517
Mailing Address - Country:US
Mailing Address - Phone:708-371-3105
Mailing Address - Fax:708-390-2105
Practice Address - Street 1:11560 S KEDZIE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MERRIONETTE PARK
Practice Address - State:IL
Practice Address - Zip Code:60803-4517
Practice Address - Country:US
Practice Address - Phone:708-371-3105
Practice Address - Fax:708-390-2105
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036041857208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621679OtherBCBS OF IL
ILP00000362OtherRAILROAD MEDICARE KANKAKEE
IL060042342OtherRAILROAD MEDICARE COOK
IL01621208OtherBLUECROSSBLUESHIELD
IL036041857Medicaid
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
IL036041857Medicaid
ILL57385Medicare ID - Type UnspecifiedGROUP 236550
ILCG1672OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILC 41424Medicare UPIN
IL060042342OtherRAILROAD MEDICARE COOK
IL036041857Medicaid