Healthcare Provider Details

I. General information

NPI: 1164418547
Provider Name (Legal Business Name): RODICA DUMITRU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 MCCLINTOCK DR SUITE 201
BURR RIDGE IL
60527-0872
US

IV. Provider business mailing address

901 MCCLINTOCK DR SUITE 202
BURR RIDGE IL
60527-0872
US

V. Phone/Fax

Practice location:
  • Phone: 888-220-6431
  • Fax: 630-654-4253
Mailing address:
  • Phone: 888-220-6431
  • Fax: 630-654-4253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number34469
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number036-072537
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: