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NPI Code Detail

MEDICARE: DR. NATASHA MARIE VON ROENN M.D.

MEDICARE: DR. NATASHA MARIE VON ROENN 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
1207RI0008XHepatology Physician036115257IL

General Provider Information

NPI Number : 1821297870
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. NATASHA MARIE VON ROENN M.D.
Provider Business Mailing Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-3774
Fax Number :
Provider Business Practice Location Address
First Line : 2160 S 1ST AVE
Second Line :
City : MAYWOOD
State : IL
Zip : 60153-3328
Country : US
Telephone Number : 708-216-3774
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/11/2007
Last Update Date : 05/14/2021

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