Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036348961 | IL |
NPI | 1003874827 |
---|---|
Provider Name | Dr. Robert David Halstead |
First Address | Mchenry, IL 60050 |
Second Address | Mchenry, IL 60050-8419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 01/08/2017 |