Healthcare Provider Details

I. General information

NPI: 1801091392
Provider Name (Legal Business Name): MEGAN PATRICIA WOITAS-RODRIGUEZ D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N HIGHLAND AVE
AURORA IL
60506-3814
US

IV. Provider business mailing address

400 N HIGHLAND AVE
AURORA IL
60506-3814
US

V. Phone/Fax

Practice location:
  • Phone: 630-892-4355
  • Fax:
Mailing address:
  • Phone: 630-892-4355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036118140
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: