Provider Demographics
NPI:1508830456
Name:FLANIGAN, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CHARLES
Last Name:FLANIGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:FAHEY BLDG ROOM 267
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:708-216-5100
Mailing Address - Fax:708-216-8991
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:FAHEY BLDG ROOM 270
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:708-216-5100
Practice Address - Fax:708-216-8991
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36073214208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36073214Medicaid
C43266Medicare UPIN
ILK15240Medicare ID - Type Unspecified
ILL80640Medicare ID - Type Unspecified