Provider Demographics
NPI:1568449098
Name:FROST, ROBERT W (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:FROST
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 1:3 DO IT DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:IL
Mailing Address - Zip Code:62411-1135
Mailing Address - Country:US
Mailing Address - Phone:618-483-6131
Mailing Address - Fax:618-483-6718
Practice Address - Street 1:3 DO IT DR
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:IL
Practice Address - Zip Code:62411-1135
Practice Address - Country:US
Practice Address - Phone:618-483-6131
Practice Address - Fax:618-483-6718
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-097024207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL275198OtherPERSONAL CARE
IL036097024Medicaid
IL042155OtherHEALTH ALLIANCE
IL347560OtherMEDICARE GROUP NUMBER
IL740352OtherHEALTHLINK
IL371329873005Medicaid
ILP00303541OtherRAILROAD MEDICARE
ILP00303541OtherRAILROAD MEDICARE
ILP00303541Medicare ID - Type UnspecifiedRAILROAD
IL148938Medicare Oscar/Certification
ILK26185Medicare PIN
ILBF4665557OtherDEA #
IL148997Medicare Oscar/Certification
IL740352OtherHEALTHLINK