Basic Information
| Provider Information | |||||||||
| NPI: | 1568449098 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FROST | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 3 DO IT DR | ||||||||
| Address2: | |||||||||
| City: | ALTAMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624111135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184836131 | ||||||||
| FaxNumber: | 6184836718 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 DO IT DR | ||||||||
| Address2: | |||||||||
| City: | ALTAMONT | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624111135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184836131 | ||||||||
| FaxNumber: | 6184836718 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2005 | ||||||||
| LastUpdateDate: | 03/12/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 03/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036-097024 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 275198 | 01 | IL | PERSONAL CARE | OTHER | 036097024 | 05 | IL | MEDICAID | 042155 | 01 | IL | HEALTH ALLIANCE | OTHER | 347560 | 01 | IL | MEDICARE GROUP NUMBER | OTHER | 740352 | 01 | IL | HEALTHLINK | OTHER | 371329873005 | 05 | IL | MEDICAID | BF4665557 | 01 | IL | DEA # | OTHER | P00303541 | 01 | IL | RAILROAD MEDICARE | OTHER |