BRADFORD C ROBERG M.D. NPI 1316946072

NPI Information

  • NPI: 1316946072
  • Provider Name: BRADFORD C ROBERG, M.D.
  • Classification: Surgery - 2086S0122X
  • Specialization: Plastic and Reconstructive Surgery
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 5714 S STATE ROUTE 31
    CRYSTAL LAKE, IL
    ZIP 60014
  • Phone: (815) 356-7000

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NPI Details

Bradford C Roberg, M.D. is a plastic and reconstructive surgery surgery in Crystal Lake, IL. The provider is a surgeon who specializes in plastic and reconstructive surgery. Bradford C Roberg, M.D. NPI is 1316946072. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

5714 S STATE ROUTE 31
CRYSTAL LAKE, IL
ZIP 60014-520
Phone: (815) 356-7000
Fax: (815) 356-7513

The NPI 1316946072 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 7/15/2005 and was last updated on 7/8/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0122XSurgeryPlastic and Reconstructive SurgeryILLINOISYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
100732007OTHERILLINOISBLUE SHIELD OF ILLINOIS
2319960MEDICARE ID-TYPE UNSPECIFIEDILLINOIS
3C75640MEDICARE UPINILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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