Individual
ROBERT LEO BLACK JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 W PARK ST, URBANA, IL 61801-2334
(217) 337-2000
Mailing address
75 REMITT DRIVE, LOCKBOX 6053, CHICAGO, IL 60675-6053
(866) 916-5259
(231) 922-4030
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036-085333
IL
207P00000X
Emergency Medicine Physician
34824-020
WI
207P00000X
Emergency Medicine Physician
J6877
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085333
—
IL
Enumeration date
07/14/2006
Last updated
12/10/2015
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