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General NPI Number Information
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NPI Number | 1174021893
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Entity Type | Individual
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Provider Name | GIOVANNI RODRIGUEZ
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Gender | Male
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Dates
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Enumeration Date | 01/29/2018
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Last Update Date | 03/17/2025
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Provider Practice Location Address
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Address Line | 1945 W WILSON AVE STE 5110
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City | CHICAGO
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State | IL
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Zip | 60640-5258
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Country | US
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Telephone | 773-878-6600
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Fax | 773-754-8431
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Provider Business Mailing Address
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Address Line | 1945 W WILSON AVE STE 5110
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City | CHICAGO
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State | IL
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Zip | 60640-5258
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Country | US
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Telephone | 773-878-6600
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Fax | 773-754-8431
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209.016539
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209016539
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License Number State | IL
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