Healthcare Provider Details

I. General information

NPI: 1275285348
Provider Name (Legal Business Name): RODNEY HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2022
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 W 72ND ST
CHICAGO IL
60636-3648
US

IV. Provider business mailing address

2233 W 72ND ST
CHICAGO IL
60636-3648
US

V. Phone/Fax

Practice location:
  • Phone: 872-236-9528
  • Fax:
Mailing address:
  • Phone: 872-236-9528
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247ZC0005X
TaxonomyClinical Laboratory Director (Non-physician)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: