Provider Demographics
NPI:1053359182
Name:RIVERS, ROBERT RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:RIVERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 RANDALL RD STE 202
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-4204
Mailing Address - Country:US
Mailing Address - Phone:630-232-1818
Mailing Address - Fax:630-232-1868
Practice Address - Street 1:302 RANDALL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-4209
Practice Address - Country:US
Practice Address - Phone:630-232-1818
Practice Address - Fax:630-232-1868
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-047518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
01643720830OtherMEDICAL EDUCATION NUMBER
730670Medicare ID - Type Unspecified
01643720830OtherMEDICAL EDUCATION NUMBER