Healthcare Provider Details

I. General information

NPI: 1508841701
Provider Name (Legal Business Name): ANA-MARIA SOLEANICOV MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 MCFARLAND RD UNIVERSITY WOMEN & CHILDREN'S HEALTH CENTER
ROCKFORD IL
61107-6807
US

IV. Provider business mailing address

1601 PARKVIEW AVE CREDENTIALING S200
ROCKFORD IL
61107-1822
US

V. Phone/Fax

Practice location:
  • Phone: 815-637-0000
  • Fax: 815-637-0040
Mailing address:
  • Phone: 815-395-5851
  • Fax: 815-395-5644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: