Provider Demographics
NPI:1104256627
Name:ROBERT A. HOZMAN MD SC
Entity type:Organization
Organization Name:ROBERT A. HOZMAN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBINSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-673-8473
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-0097
Mailing Address - Country:US
Mailing Address - Phone:847-673-8473
Mailing Address - Fax:
Practice Address - Street 1:555 CORPORATE WOODS PKWY
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-3111
Practice Address - Country:US
Practice Address - Phone:847-673-8473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036067290207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036067290Medicaid