Basic Information
Provider Information
NPI: 1003016965
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ABRAMS
FirstName: ROBERT
MiddleName: MARC
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 19640
Address2:  
City: SPRINGFIELD
State: IL
PostalCode: 627949640
CountryCode: US
TelephoneNumber: 2175455117
FaxNumber: 2175454912
Practice Location
Address1: 415 N 9TH ST
Address2: 6W100
City: SPRINGFIELD
State: IL
PostalCode: 627025303
CountryCode: US
TelephoneNumber: 2175455117
FaxNumber: 2175454912
Other Information
ProviderEnumerationDate: 07/19/2007
LastUpdateDate: 08/31/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207VM0101X036-102660ILY Allopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

ID Information
IDTypeStateIssuerDescription
03610266005IL MEDICAID


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