Healthcare Provider Details

I. General information

NPI: 1427128909
Provider Name (Legal Business Name): RODNEY ALFORD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 N WALL ST SUITE 206
KANKAKEE IL
60901-2934
US

IV. Provider business mailing address

200E FAIRMAN AVE
WATSEKA IL
60970-1644
US

V. Phone/Fax

Practice location:
  • Phone: 815-937-2044
  • Fax: 815-937-2029
Mailing address:
  • Phone: 815-432-5841
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036068108
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036068108
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: