Basic Information
| Provider Information | |||||||||
| NPI: | 1003874827 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HALSTEAD | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | DAVID | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR | ||||||||
| Address2: | STE B310 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60050 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4309 W MEDICAL CENTER DR | ||||||||
| Address2: | SUITE B310 | ||||||||
| City: | MCHENRY | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600508419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153443900 | ||||||||
| FaxNumber: | 8157594666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/02/2006 | ||||||||
| LastUpdateDate: | 08/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 036348961 | IL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.