Provider Demographics
NPI:1194940106
Name:BESTER, ROBERT M (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BESTER
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 1:2945 AUTUMN DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60517
Mailing Address - Country:US
Mailing Address - Phone:630-586-0110
Mailing Address - Fax:630-586-0120
Practice Address - Street 1:2945 AUTUMN DRIVE
Practice Address - Street 2:
Practice Address - City:WOODRIDGE
Practice Address - State:IL
Practice Address - Zip Code:60517
Practice Address - Country:US
Practice Address - Phone:630-586-0110
Practice Address - Fax:630-586-0120
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.003027213E00000X
IL316.000674213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480022587OtherRR MEDICARE
IL480022587OtherRR MEDICARE
IL4880110001Medicare NSC