Healthcare Provider Details

I. General information

NPI: 1649271685
Provider Name (Legal Business Name): RWR MEDICAL ARTS SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2005
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1002 N ALLEN ST
ROBINSON IL
62454-1167
US

IV. Provider business mailing address

1002 N ALLEN ST
ROBINSON IL
62454-1167
US

V. Phone/Fax

Practice location:
  • Phone: 618-544-7050
  • Fax: 618-544-3738
Mailing address:
  • Phone: 618-544-7050
  • Fax: 618-544-3738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036081314
License Number StateIL

VIII. Authorized Official

Name: DAVID D ROTMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 618-544-7050