Provider Demographics
NPI:1134199953
Name:ROBELEN, JAMES V (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:V
Last Name:ROBELEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 727
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-0727
Mailing Address - Country:US
Mailing Address - Phone:618-998-8346
Mailing Address - Fax:618-997-3942
Practice Address - Street 1:3106 OUTER DR
Practice Address - Street 2:SUITE 100
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-5270
Practice Address - Country:US
Practice Address - Phone:618-998-8346
Practice Address - Fax:618-997-3942
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036112331208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036112331Medicaid
IL036112331Medicaid
H29838Medicare UPIN
WI000007021Medicare PIN