Basic Information
| Provider Information | |||||||||
| NPI: | 1679589717 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDEN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | NORMAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 980 N MICHIGAN AVE | ||||||||
| Address2: | STE. 800 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122387800 | ||||||||
| FaxNumber: | 3122387801 | ||||||||
| Practice Location | |||||||||
| Address1: | 980 N MICHIGAN AVE | ||||||||
| Address2: | STE. 800 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3122387800 | ||||||||
| FaxNumber: | 3122387801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 02/07/2014 | ||||||||
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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 | 2081P2900X | 036-087401 | IL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 2084N0400X | 036-087401 | IL | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 208VP0000X | 036-087401 | IL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 250011898 | 01 | IL | RAILROAD MEDICARE | OTHER | 250011899 | 01 | IL | RAILROAD MEDICARE | OTHER | 036087401 | 05 | IL | MEDICAID |