Provider Demographics
NPI:1932109337
Name:SHARE, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:SHARE
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 1:10400 SOUTHWEST HWY
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1367
Mailing Address - Country:US
Mailing Address - Phone:708-581-7308
Mailing Address - Fax:708-581-7309
Practice Address - Street 1:10400 SOUTHWEST HWY
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1367
Practice Address - Country:US
Practice Address - Phone:708-581-7308
Practice Address - Fax:708-581-7309
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2009-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360769902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036076990Medicaid
1467471540OtherAUS GROUP NPI
IL02232706OtherBCBS PROVIDER NUMBER
IL759800Medicare PIN
ILDE9375Medicare PIN
ILL16777Medicare PIN
ILE87203Medicare UPIN
IL920000521Medicare PIN
IL02232706OtherBCBS PROVIDER NUMBER
5433040001Medicare NSC