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NPI Code Detail

MEDICARE: MARIEL SEBASTIANA ROGOZINSKI DO, MSA, MSMED, EMT

MEDICARE: MARIEL SEBASTIANA ROGOZINSKI DO, MSA, MSMED, EMT
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
1207P00000XEmergency Medicine Physician036179773IL
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1780379776
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIEL SEBASTIANA ROGOZINSKI DO, MSA, MSMED, EMT
Provider Business Mailing Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-655-2109
Fax Number :
Provider Business Practice Location Address
First Line : 530 NE GLEN OAK AVE
Second Line :
City : PEORIA
State : IL
Zip : 61637-0001
Country : US
Telephone Number : 309-655-2109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2023
Last Update Date : 04/21/2026

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