Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 036042512 | IL |
NPI | 1093719908 |
---|---|
Provider Name | Dr. Robert Jay Hart |
First Address | Flossmoor, IL 60422-4385 |
Second Address | Flossmoor, IL 60422-4385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 02/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D13115 | (02) |