Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | 036070596 | IL |
NPI | 1043327927 |
---|---|
Provider Name | Dr. Roger Rodby |
First Address | Chicago, IL 60607-1821 |
Second Address | Chicago, IL 60607-1821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 25/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01615381 | BC/BS ID NUMBER (01) | IL |
036070596 | (05) | IL |
110042308 | RR MEDICARE (01) | GA |
C38446 | (02) | IL |