Provider Demographics
NPI:1992278196
Name:ROBERSON, DEANGELA (SA)
Entity type:Individual
Prefix:
First Name:DEANGELA
Middle Name:
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 SCHOOL DR
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-4986
Mailing Address - Country:US
Mailing Address - Phone:708-439-0652
Mailing Address - Fax:
Practice Address - Street 1:1212 N. LASALLE
Practice Address - Street 2:STE 100/ SURGERY CENTER
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610
Practice Address - Country:US
Practice Address - Phone:312-943-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Multi-Specialty