Bradford C Roberg
Plastic and Reconstructive Surgery
5714 S State Route 31
Crystal Lake
, Illinois 60014-4520
Bradford C Roberg
Plastic and Reconstructive Surgery
5714 S State Route 31
Crystal Lake
, Illinois 60014-4520
(847) 967-8594
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About
Features
Specialties
- Plastic and Reconstructive Surgery
Languages spoken
- English
Location
First Address
- Bradford C Roberg
- 8135 N Milwaukee Ave
- Niles, IL
- Zip : 60714-2828
- Fax : (847) 967-8594
- Phone : (847) 967-8098
Second Address
- Bradford C Roberg
- 5714 S State Route 31
- Crystal Lake, IL
- Zip : 60014-4520
- Fax : (815) 356-7513
- Phone : (815) 356-7000
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 2086S0122X | Plastic and Reconstructive Surgery | IL |
National Provider Identifier
| NPI | 1316946072 |
|---|---|
| Provider Name | Bradford C Roberg |
| First Address | Niles, IL 60714-2828 |
| Second Address | Crystal Lake, IL 60014-4520 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/07/2005 |
| Last Update Date | 08/07/2007 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 00732007 | BLUE SHIELD OF ILLINOIS (01) | IL |
| C75640 | (02) | IL |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.