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General NPI Number Information
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NPI Number | 1831369800
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH ASSOCIATES, P.C.
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Dates
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Enumeration Date | 03/06/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 1715 DIVISION ST SUITE A
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City | MORRIS
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State | IL
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Zip | 60450-3100
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Country | US
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Telephone | 815-942-1550
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Fax | 815-942-8419
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Provider Business Mailing Address
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Address Line | 1100 HOUBOLT RD
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City | JOLIET
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State | IL
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Zip | 60431-9063
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Country | US
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Telephone | 815-725-5950
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Fax | 815-725-3666
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. RICHARD ROTNICKI
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Credential | D.O.
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Telephone | 815-725-5950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State | IL
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