Provider Demographics
NPI:1992760540
Name:ROBLES, SANDRA Y (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:Y
Last Name:ROBLES
Suffix:
Gender:F
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:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:STE. LL-2
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1319
Practice Address - Country:US
Practice Address - Phone:502-636-8095
Practice Address - Fax:502-636-8097
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY30019207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000278533OtherANTHEM / NCMA
KY000028412DOtherHUMANA / NCMA
KY020887OtherSIHO / NCMA
KYP00009339OtherRAILROAD MEDICARE
KY50000962OtherPASSPORT / NCMA
KY2442617000OtherPASSPORT ADVANTAGE / NCMA
KY64300197Medicaid
IN200156630Medicaid
KY000000278533OtherANTHEM / NCMA
KY0361987Medicare PIN