Healthcare Provider Details

I. General information

NPI: 1659794311
Provider Name (Legal Business Name): DONALD KARL JOSEPH ROKOSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2014
Last Update Date: 01/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 N WALNUT ST
DANVILLE IL
61832-2516
US

IV. Provider business mailing address

1433 N WALNUT ST
DANVILLE IL
61832-2516
US

V. Phone/Fax

Practice location:
  • Phone: 217-474-1254
  • Fax:
Mailing address:
  • Phone: 217-474-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-058411
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: