Basic Information
| Provider Information | |||||||||
| NPI: | 1134117229 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KOJIMA | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 EAST CARPENTER STREET | ||||||||
| Address2: | ROOM 2K64 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175255643 | ||||||||
| FaxNumber: | 2175442521 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 EAST CARPENTER STREET | ||||||||
| Address2: | ROOM 2K64 | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 627690001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2175255643 | ||||||||
| FaxNumber: | 2175442521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 207L00000X | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 08415040 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 178785 | 01 | IL | HEALTHLINK UPIN# | OTHER | 085972 | 01 | IL | HEALTH ALLIANCE NUMBER | OTHER | 104409 | 01 | IL | HEALTHLINK GROUP NUMBER | OTHER | 32490 | 01 | IL | PERSONAL CARE | OTHER |