Provider Demographics
NPI:1558300038
Name:TANNEY, ROBERT W (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:TANNEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W LAKE COOK RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2082
Mailing Address - Country:US
Mailing Address - Phone:847-520-9424
Mailing Address - Fax:847-520-9479
Practice Address - Street 1:650 W LAKE COOK RD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2082
Practice Address - Country:US
Practice Address - Phone:847-520-9424
Practice Address - Fax:847-520-9479
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036073747207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16622Medicare UPIN