MEDICARE: GEORGE ROTRAMEL DMD

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	122300000X	Dentist	19-024565	IL

General Provider Information

NPI Number	:	1376967711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE ROTRAMEL DMD

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	:

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	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2014
Last Update Date	:	02/05/2014

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