Healthcare Provider Details

I. General information

NPI: 1023767977
Provider Name (Legal Business Name): HAYDEN ELISE ROTRAMEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W CARPENTER ST
SPRINGFIELD IL
62702-4901
US

IV. Provider business mailing address

PO BOX 19636
SPRINGFIELD IL
62794-9636
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax: 217-545-5459
Mailing address:
  • Phone: 217-545-8000
  • Fax: 217-545-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1023767977
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number036.178605
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: