MEDICARE: GEORGE A. ROTRAMEL DMD LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	019.024565	IL

General Provider Information

NPI Number	:	1265536890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGE A. ROTRAMEL DMD LTD

Provider Business Mailing Address
First Line	:	113 E PEMBROKE ST
Second Line	:
City	:	TUSCOLA
State	:	IL
Zip	:	61953-1427
Country	:	US
Telephone Number	:	217-253-5222
Fax Number	:	217-253-5223

Provider Business Practice Location Address
First Line	:	113 E PEMBROKE ST
Second Line	:
City	:	TUSCOLA
State	:	IL
Zip	:	61953-1427
Country	:	US
Telephone Number	:	217-253-5222
Fax Number	:	217-253-5223

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	DR. GEORGE ANTHONY ROTRAMEL
Credential	:	D. M.D.
Telephone Number	:	217-253-5222

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/31/2008

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