Provider Demographics
NPI:1184713455
Name:BASTIAN, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:BASTIAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3010 HIGHLAND PKWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515
Mailing Address - Country:US
Mailing Address - Phone:630-724-1100
Mailing Address - Fax:630-724-0084
Practice Address - Street 1:3010 HIGHLAND PKWY STE 250
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5545
Practice Address - Country:US
Practice Address - Phone:630-724-1100
Practice Address - Fax:630-724-0084
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2024-08-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036059793207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL90008415246206Medicaid
IL90008415246206Medicaid
D14665Medicare UPIN