Individual
ROBERT D CHILDERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
400 MAPLE SUMMIT RD, STE 300, JERSEYVILLE, IL 62052-2028
(618) 498-8470
(618) 498-8488
Mailing address
PO BOX 28, JERSEYVILLE, IL 62052-0028
(618) 498-8470
(618) 498-8488
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
01093287A
IN
208800000X
Urology Physician
Primary
036073486
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006000528
BLUE CROSS BLUE SHIELD
IL
05
—
036073486
—
IL
01
—
2822
BLUE CROSS BLUE SHIELD
MO
01
—
340014235
RAILROAD MEDICARE
IL
Enumeration date
09/20/2005
Last updated
04/15/2024
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