Healthcare Provider Details

I. General information

NPI: 1780905604
Provider Name (Legal Business Name): EVELYN RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVELYN RODRIGUEZ HERRADA M.D.

II. Dates (important events)

Enumeration Date: 06/15/2010
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 WILLOW SPRINGS RD SUITE 490
LA GRANGE HIGHLANDS IL
60525-6537
US

IV. Provider business mailing address

PO BOX 713260
CHICAGO IL
60677-1260
US

V. Phone/Fax

Practice location:
  • Phone: 708-859-1497
  • Fax:
Mailing address:
  • Phone: 630-469-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036-126181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: