Provider Demographics
NPI:1992995625
Name:ROBERT T. EGEL, M. D., S. C.
Entity type:Organization
Organization Name:ROBERT T. EGEL, M. D., S. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:TERRELL
Authorized Official - Last Name:EGEL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:708-684-5445
Mailing Address - Street 1:4440 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2600
Mailing Address - Country:US
Mailing Address - Phone:708-684-5445
Mailing Address - Fax:708-684-3112
Practice Address - Street 1:4440 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2699
Practice Address - Country:US
Practice Address - Phone:708-684-5445
Practice Address - Fax:708-684-3112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208938Medicare PIN
IL208939Medicare PIN
ILC39487Medicare UPIN