Basic Information
Provider Information | |||||||||
NPI: | 1871703215 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HAND | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | MITCHUM | ||||||||
NamePrefix: | MR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | O.T.C. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1310 VALLEY LAKE DR | ||||||||
Address2: | APT.440 | ||||||||
City: | SCHAUMBURG | ||||||||
State: | IL | ||||||||
PostalCode: | 601953637 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8475191935 | ||||||||
FaxNumber: | 8475191935 | ||||||||
Practice Location | |||||||||
Address1: | 901 BIESTERFIELD RD | ||||||||
Address2: | SUITE 300 | ||||||||
City: | ELK GROVE VILLAGE | ||||||||
State: | IL | ||||||||
PostalCode: | 600073392 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8474379889 | ||||||||
FaxNumber: | 8473012829 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2007 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 247200000X |   |   | Y |   | Technologists, Technicians & Other Technical Service Providers | Technician, Other |   |
No ID Information.