Organization
NORTHERN ILLINOIS PLASTIC SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRADFORD C. ROBERG M.D. (PRESIDENT)
(847) 967-1149
Entity
Organization
Contact information
Practice address
5714 S IL ROUTE 31, SUITE A, CRYSTAL LAKE, IL 60014-4520
(815) 356-7000
(815) 356-7513
Mailing address
8135 N MILWAUKEE AVE, NILES, IL 60714-2828
(847) 967-1149
(847) 967-8594
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00732007
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
06/03/2006
Last updated
08/22/2020
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