Provider Demographics
NPI:1124052717
Name:JOSEPH, ROBERT M (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60064-3090
Mailing Address - Country:US
Mailing Address - Phone:937-479-1793
Mailing Address - Fax:847-775-6587
Practice Address - Street 1:3471 GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:NORTH CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60064-3090
Practice Address - Country:US
Practice Address - Phone:937-479-1793
Practice Address - Fax:847-775-6587
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH003440213E00000X
IL016.005534213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2684751OtherMEDICAID
OH421534506145OtherCARESOURCE
OH421534506011OtherTRICARE
OH7195856OtherAETNA
OH000000605109OtherBCBS-OH
OH4184255Medicare PIN
OH421534506011OtherTRICARE
J04184251Medicare PIN
OH000000605109OtherBCBS-OH
OH2684751OtherMEDICAID