Provider Demographics
NPI:1982677597
Name:PODE, ROBERT PATRICK (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PATRICK
Last Name:PODE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:102 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:STREATOR
Mailing Address - State:IL
Mailing Address - Zip Code:61364-2127
Mailing Address - Country:US
Mailing Address - Phone:815-672-4600
Mailing Address - Fax:815-672-3333
Practice Address - Street 1:102 W ELM ST
Practice Address - Street 2:
Practice Address - City:STREATOR
Practice Address - State:IL
Practice Address - Zip Code:61364-2127
Practice Address - Country:US
Practice Address - Phone:815-672-4600
Practice Address - Fax:815-672-3333
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-093170207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG31398Medicare UPIN
ILK09735Medicare PIN