Provider Demographics
NPI:1669403457
Name:KOLBUSZ, ROBERT VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:VINCENT
Last Name:KOLBUSZ
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 1:2500 S HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5363
Mailing Address - Country:US
Mailing Address - Phone:630-964-2000
Mailing Address - Fax:630-964-6378
Practice Address - Street 1:2500 S HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5363
Practice Address - Country:US
Practice Address - Phone:630-964-2000
Practice Address - Fax:630-964-6378
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-070368207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF55210Medicare UPIN
IL214134Medicare PIN