Healthcare Provider Details

I. General information

NPI: 1841317195
Provider Name (Legal Business Name): ROLANDO M GARCES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 S ASHLAND SUITE 110
CHICAGO IL
60608-1318
US

IV. Provider business mailing address

7428 KOLMAR AVE
SKOKIE IL
60076-2626
US

V. Phone/Fax

Practice location:
  • Phone: 773-254-5516
  • Fax:
Mailing address:
  • Phone: 847-675-4085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number036-057653
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: