Provider Demographics
NPI:1679587786
Name:BANDYK, ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BANDYK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18503 TORRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438-2839
Mailing Address - Country:US
Mailing Address - Phone:708-474-1900
Mailing Address - Fax:708-474-1037
Practice Address - Street 1:18503 TORRENCE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438-2839
Practice Address - Country:US
Practice Address - Phone:708-474-1900
Practice Address - Fax:708-474-1037
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-004010213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL480014821OtherRR
IL016004010Medicaid
IL6000-1-555OtherBC/BS
IL6000-1-555OtherBC/BS
IL016004010Medicaid
ILL05771Medicare PIN
480013293Medicare PIN
T38575Medicare UPIN
IL6000-1-555OtherBC/BS
ILL75811Medicare PIN
IL6000-1-555OtherBC/BS
480013293Medicare PIN
ILL05771Medicare PIN