Healthcare Provider Details

I. General information

NPI: 1922074764
Provider Name (Legal Business Name): CAROL J ROWE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2006
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 W. FAIRCHILD STREET PEDIATRICS
DANVILLE IL
61832
US

IV. Provider business mailing address

P.O. BOX 6002
URBANA IL
61803-6002
US

V. Phone/Fax

Practice location:
  • Phone: 217-431-7800
  • Fax: 217-431-7634
Mailing address:
  • Phone: 217-326-8300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00044142
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: