MEDICARE: DR. CHRISTOPHER RODARTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036.158407	IL
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1275026171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER RODARTE MD

Provider Business Mailing Address
First Line	:	800 E 55TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60615-4906
Country	:	US
Telephone Number	:	312-682-6110
Fax Number	:

Provider Business Practice Location Address
First Line	:	4802 S ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60609-4233
Country	:	US
Telephone Number	:	773-376-9400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	02/07/2022

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