1831369800 NPI number — DIGESTIVE HEALTH ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831369800 NPI number — DIGESTIVE HEALTH ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DIGESTIVE HEALTH ASSOCIATES, P.C.
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:
1831369800
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 HOUBOLT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOLIET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60431-9063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-725-5950
Provider Business Mailing Address Fax Number:
815-725-3666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1715 DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
MORRIS
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60450-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-942-1550
Provider Business Practice Location Address Fax Number:
815-942-8419
Provider Enumeration Date:
03/06/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROTNICKI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
815-725-5950

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , 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)





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