Individual
DR. ROBERT C PRENTICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
13011 S 104TH AVE STE 100, PALOS PARK, IL 60464-1508
(708) 274-3278
(708) 274-3299
Mailing address
13011 S 104TH AVE STE 100, PALOS PARK, IL 60464-1508
(708) 478-3600
(708) 478-3552
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
036067066
IL
207RI0011X
Interventional Cardiology Physician
036067066
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01621208
BLUE CROSS BLUE SHIELD
IL
05
—
036067066
—
IL
01
—
060042297
RAILROAD MEDICARE COOK
IL
01
—
060056572
RAILROAD MEDICARE WILL
IL
01
—
1508810086
GROUP NPI
IL
01
—
236550
MEDICARE GROUP
IL
01
—
236551
MEDICARE GROUP
IL
01
—
CD8033
RAILROAD MEDICARE GROUP PTAN NUMBER
IL
01
—
CN2703
RAILROAD MEDICARE GROUP PTAN NUMBER
IL
Enumeration date
04/14/2006
Last updated
12/15/2021
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