Healthcare Provider Details

I. General information

NPI: 1407833163
Provider Name (Legal Business Name): THOMAS W ROHDE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2005
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3798 E FULTON AVE
DECATUR IL
62521-5053
US

IV. Provider business mailing address

3798 E FULTON AVE
DECATUR IL
62521-5053
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-2700
  • Fax: 217-422-3930
Mailing address:
  • Phone: 217-864-2700
  • Fax: 217-422-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036-081038
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA46499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: