Basic Information
Provider Information
NPI: 1265617203
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ORTIZ
FirstName: ROBINSON
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3701 ALGONQUIN RD
Address2: STE 900
City: ROLLING MEADOWS
State: IL
PostalCode: 600083127
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3701 ALGONQUIN RD
Address2: STE 900
City: ROLLING MEADOWS
State: IL
PostalCode: 600083127
CountryCode: US
TelephoneNumber: 8475770620
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/09/2008
LastUpdateDate: 02/24/2009
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003X036-113734ILY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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