Healthcare Provider Details

I. General information

NPI: 1245346485
Provider Name (Legal Business Name): ROZA IOFFE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HEALTH CENTER DRIVE SUITE 100
MATTOON IL
61938
US

IV. Provider business mailing address

1005 HEALTH CENTER DRIVE SUITE 100
MATTOON IL
61938
US

V. Phone/Fax

Practice location:
  • Phone: 217-258-4006
  • Fax: 217-258-4120
Mailing address:
  • Phone: 217-258-4006
  • Fax: 217-258-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036-069392
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: