Basic Information
| Provider Information | |||||||||
| NPI: | 1881601243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLNAR | ||||||||
| FirstName: | ROBERT | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 387 SHUMAN BLVD | ||||||||
| Address2: | SUITE 240W | ||||||||
| City: | NAPERVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605638450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6308682200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 701 WEST NORTH AVENUE | ||||||||
| Address2: | |||||||||
| City: | MELROSE PARK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 601601612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7086813202 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2006 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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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 | 207L00000X | 36072039 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 36072039 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 36072039 | 05 | IL | MEDICAID |