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NPI Code Detail

MEDICARE: TINA M ROZENE M.D.

MEDICARE: TINA M ROZENE M.D.
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
1207R00000XInternal Medicine Physician036094764IL
2208000000XPediatrics Physician036094764IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
5370012295OTHERILRAILROAD MEDICARE/PALMETTO GBA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2054508OTHERILHEALTH ALLIANCE #
32523659OTHERILBC/BS #
4386900OTHERILHEALTHLINK #

General Provider Information

NPI Number : 1467489807
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA M ROZENE M.D.
Provider Business Mailing Address
First Line : 1025 S 6TH ST
Second Line :
City : SPRINGFIELD
State : IL
Zip : 62703-2403
Country : US
Telephone Number : 217-528-7541
Fax Number :
Provider Business Practice Location Address
First Line : 300 N MAPLE ST
Second Line :
City : EFFINGHAM
State : IL
Zip : 62401-2003
Country : US
Telephone Number : 217-342-4151
Fax Number : 217-347-0108
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 05/20/2020

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