Basic Information
| Provider Information | |||||||||
| NPI: | 1699733014 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBSON | ||||||||
| FirstName: | CHESTER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7009 | ||||||||
| Address2: | |||||||||
| City: | BOLINGBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604407009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6303127865 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7425 JANES AVE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WOODRIDGE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605172356 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6309699096 | ||||||||
| FaxNumber: | 6309691095 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 02/28/2011 | ||||||||
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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 | 207Q00000X | 36110006 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 036110006 | 05 | IL | MEDICAID | 400480 | 01 | IL | GROUP MEDICARE PTAN | OTHER | CN4921 | 01 | IL | RRMC | OTHER |