Basic Information
| Provider Information | |||||||||
| NPI: | 1477553188 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | APPLEBAUM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | ETHAN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | APPLEBAUM | ||||||||
| OtherFirstName: | ROB | ||||||||
| OtherMiddleName: | |||||||||
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| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4400 W 95TH ST | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | OAK LAWN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604532654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083464040 | ||||||||
| FaxNumber: | 7083463287 | ||||||||
| Practice Location | |||||||||
| Address1: | 2310 YORK ST | ||||||||
| Address2: | SUITE 3A | ||||||||
| City: | BLUE ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604062411 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083712057 | ||||||||
| FaxNumber: | 7083714569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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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 | 208G00000X | 036074981 | IL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 01035864A | IN | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 200269990C | 05 | IN | MEDICAID | 200269990D | 05 | IN | MEDICAID | 036074981 | 05 | IL | MEDICAID | 01618941 | 01 | IL | BCBS | OTHER | 200269990A | 05 | IN | MEDICAID | 200269990E | 05 | IN | MEDICAID |