Robert A Hadesman, M.D.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

036072426 Issued in IL

Practice address

890 Garfield Ave
Ste 103
Libertyville, IL 60048-3100

Phone

(847) 680-5858

Fax

(847) 680-5862

NPI assigned

Jun 1, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1391126400000",
    "number": "1245234574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "890 GARFIELD AVE",
            "address_2": "STE 103",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483100",
            "telephone_number": "847-680-5858",
            "fax_number": "847-680-5862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "890 GARFIELD AVE",
            "address_2": "STE 103",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600483100",
            "telephone_number": "847-680-5858",
            "fax_number": "847-680-5862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HADESMAN",
        "first_name": "ROBERT",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2014-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "IL",
            "license": "036072426",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036072426",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Gastroenterology Physician in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Gastroenterology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.