Healthcare Provider Details

I. General information

NPI: 1447459540
Provider Name (Legal Business Name): THOMAS ROHDE, M.D., LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2007
Last Update Date: 04/13/2010
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: 217-864-3930
Mailing address:
  • Phone: 217-864-2700
  • Fax: 217-864-3930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number036081038
License Number StateIL

VIII. Authorized Official

Name: DR. THOMAS W. ROHDE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 217-864-2700