1023277019 NPI number — ROGELIO O CAVE MD SC

Table of content: (NPI 1023277019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023277019 NPI number — ROGELIO O CAVE MD SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROGELIO O CAVE MD SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023277019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9526 S KILBOURN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK LAWN
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60453-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-422-3716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
67 W 111TH ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60628-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-995-3454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/04/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOYLE
Authorized Official First Name:
ROSITA
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING CONSULTANT
Authorized Official Telephone Number:
773-846-9521

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  036050538 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 036050538-1 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21624903 . This is a "BLUECROSS BLUE SHIELD OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 111910550 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".