Healthcare Provider Details

I. General information

NPI: 1649325929
Provider Name (Legal Business Name): NELA RODRIGUEZ CORDERO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 N DAMEN AVE
CHICAGO IL
60647-4527
US

IV. Provider business mailing address

2 WELLINGBOROUGH CT
SOUTH BARRINGTON IL
60010-6156
US

V. Phone/Fax

Practice location:
  • Phone: 773-486-6553
  • Fax:
Mailing address:
  • Phone: 847-277-1740
  • Fax: 847-277-1744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number036053399
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036053399
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number036053399
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: