Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 036090185 | IL |
NPI | 1033148457 |
---|---|
Provider Name | William D. Rhoades |
First Address | Downers Grove, IL 60515-1551 |
Second Address | Park Ridge, IL 60068-1005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2006 |
Last Update Date | 23/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036090185 | (05) | IL |
G10214 | (02) | IL |
L69148 | MEDICARE ID (01) | IL |