Individual
BRADFORD C ROBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
5714 S STATE ROUTE 31, CRYSTAL LAKE, IL 60014-4520
(815) 356-7000
(815) 356-7513
Mailing address
8135 N MILWAUKEE AVE, NILES, IL 60714-2828
(847) 967-8098
(847) 967-8594
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00732007
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
07/15/2005
Last updated
07/08/2007
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