1780759332 NPI number — DR. ROBIN S. ROSS PH.D.

Table of content: DR. ROBIN S. ROSS PH.D. (NPI 1780759332)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780759332 NPI number — DR. ROBIN S. ROSS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSS
Provider First Name:
ROBIN
Provider Middle Name:
S.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780759332
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 LAKE COOK RD
Provider Second Line Business Mailing Address:
SUITE 113
Provider Business Mailing Address City Name:
DEERFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60015-5646
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-405-0220
Provider Business Mailing Address Fax Number:
847-405-0215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 LAKE COOK RD
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
DEERFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60015-5646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-405-0220
Provider Business Practice Location Address Fax Number:
847-405-0215
Provider Enumeration Date:
11/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 422-6178 . This is a "AETNA PROVIDER NO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 04972104 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 056-596 . This is a "VALUE OPTIONS PROVIDER NO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 055043 . This is a "MAGELLAN PROVIDER NO" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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