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NPI Code Detail

MEDICARE: DAVID C ROSBOROUGH MD

MEDICARE: DAVID C ROSBOROUGH MD
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
1207RN0300XNephrology Physician036079640IL
2207RH0005XHypertension Specialist Physician036079640IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1390002053OTHERILRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1619007275
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID C ROSBOROUGH MD
Provider Business Mailing Address
First Line : 420 NE GLEN OAK AVE STE 401
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-676-8123
Fax Number : 309-676-8455
Provider Business Practice Location Address
First Line : 420 NE GLEN OAK AVE STE 401
Second Line :
City : PEORIA
State : IL
Zip : 61603-3112
Country : US
Telephone Number : 309-676-8123
Fax Number : 309-676-8455
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 01/08/2024

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Directions to “ DAVID C ROSBOROUGH MD” Practice Location

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