Provider Demographics
NPI:1013972850
Name:LICHTENBERG, ROBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:C
Last Name:LICHTENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19001 OLD LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-8012
Mailing Address - Country:US
Mailing Address - Phone:708-478-3600
Mailing Address - Fax:708-478-3552
Practice Address - Street 1:3231 EUCLID AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3471
Practice Address - Country:US
Practice Address - Phone:708-783-2055
Practice Address - Fax:708-783-2181
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068028207RC0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01621208OtherBLUECROSS BLUE SHIELD
ILK10093OtherMEDICARE INDIVIDUAL PTAN
IL036068028Medicaid
IL236551OtherMEDICARE GROUP PTAN
IL416810OtherMEDICARE GROUP PTAN
ILR00334OtherMEDICARE INDIVIDUAL PTAN
IL236550OtherMEDICARE GROUP PTAN
ILK10092OtherMEDICARE INDIVIDUAL PTAN
IL1508810086OtherGROUP NPI
ILCD8033OtherRAILROAD MEDICARE GROUP PTAN NUMBER
ILP00157668OtherRAILROAD MEDICARE COOK
IL036068028Medicaid