Provider Demographics
NPI:1376516245
Name:ATTEBERRY, ROBERT KINGSLEY (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KINGSLEY
Last Name:ATTEBERRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 7412049
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-2049
Mailing Address - Country:US
Mailing Address - Phone:314-525-0580
Mailing Address - Fax:314-525-0581
Practice Address - Street 1:3844 S LINDBERGH BLVD
Practice Address - Street 2:STE 216
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63127-1416
Practice Address - Country:US
Practice Address - Phone:314-525-0580
Practice Address - Fax:314-525-0581
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO1999140355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205293715Medicaid
I03897Medicare UPIN