Healthcare Provider Details

I. General information

NPI: 1093704942
Provider Name (Legal Business Name): DANIEL ROCCO MORRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1941 FRANK SCOTT PKWY E
SHILOH IL
62269-7387
US

IV. Provider business mailing address

1941 FRANK SCOTT PKWY E
SHILOH IL
62269-7387
US

V. Phone/Fax

Practice location:
  • Phone: 618-526-8850
  • Fax: 618-526-8852
Mailing address:
  • Phone: 618-526-8850
  • Fax: 618-526-8852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number2002009364
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2002009364
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036106660
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2002009364
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: