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General NPI Number Information
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NPI Number | 1861440661
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Entity Type | Individual
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Provider Name | GUILLERMO RODRIGUEZ JR. MD
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Gender | Male
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 04/21/2025
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Provider Practice Location Address
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Address Line | 4500 MEMORIAL DR DIV MEDICAL ONCOLOGY
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City | BELLEVILLE
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State | IL
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Zip | 62226-5360
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Country | US
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Telephone | 800-647-2098
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Fax | 314-362-3192
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 800-647-2098
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Fax | 314-362-3192
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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 | 207RX0202X
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Taxonomy Name | Medical Oncology Physician
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License Number | 036070727
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License Number State | IL
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