Provider Demographics
NPI:1487607891
Name:ROBIN, BEVERLEY (MD)
Entity type:Individual
Prefix:DR
First Name:BEVERLEY
Middle Name:
Last Name:ROBIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1464 S MICHIGAN AVE
Mailing Address - Street 2:SUITE 1304
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60605-3711
Mailing Address - Country:US
Mailing Address - Phone:773-320-5727
Mailing Address - Fax:312-939-0188
Practice Address - Street 1:1464 S MICHIGAN AVE
Practice Address - Street 2:SUITE 1304
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60605-3711
Practice Address - Country:US
Practice Address - Phone:773-320-5727
Practice Address - Fax:312-939-0188
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361004132080N0001X
IN01065473A2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200263150Medicaid
IL036100413Medicaid
IN000000647638OtherANTHEM
IN000000632893OtherANTHEM PROVIDER NUMBER
KS200606090AMedicaid
IN815500CC2Medicare PIN
H86059Medicare UPIN
KS110679004Medicare UPIN
KS200606090AMedicaid