Healthcare Provider Details

I. General information

NPI: 1164519054
Provider Name (Legal Business Name): MANUEL O ROJAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 06/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4254 W 55TH ST
CHICAGO IL
60632
US

IV. Provider business mailing address

4254 W 55TH ST
CHICAGO IL
60632
US

V. Phone/Fax

Practice location:
  • Phone: 773-582-5200
  • Fax: 773-582-2771
Mailing address:
  • Phone: 773-582-5200
  • Fax: 773-582-2771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0360496461
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: