MEDICARE: DR. REBECCA SUSANNE ROCKERS M.D.

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	207Q00000X	Family Medicine Physician	01048955A	IN

General Provider Information

NPI Number	:	1598748121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REBECCA SUSANNE ROCKERS M.D.

Provider Business Mailing Address
First Line	:	3371 W CLEVELAND ROAD EXT STE 201
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-9780
Country	:	US
Telephone Number	:	574-218-6700
Fax Number	:	574-218-6708

Provider Business Practice Location Address
First Line	:	3371 W CLEVELAND ROAD EXT STE 120
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-9780
Country	:	US
Telephone Number	:	574-219-6700
Fax Number	:	574-218-6708

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

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	06/18/2022

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