Provider Demographics
NPI:1013027945
Name:LEFEBVRE, ROCH ANDRE (MD)
Entity Type:Individual
Prefix:
First Name:ROCH
Middle Name:ANDRE
Last Name:LEFEBVRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 HOLY CROSS LN
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BREESE
Mailing Address - State:IL
Mailing Address - Zip Code:62230-3510
Mailing Address - Country:US
Mailing Address - Phone:618-526-7271
Mailing Address - Fax:618-526-7313
Practice Address - Street 1:9401 HOLY CROSS LN
Practice Address - Street 2:SUITE 112
Practice Address - City:BREESE
Practice Address - State:IL
Practice Address - Zip Code:62230-3510
Practice Address - Country:US
Practice Address - Phone:618-526-7271
Practice Address - Fax:618-526-7313
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089921Medicaid
ILL35400Medicare PIN
IL392880Medicare ID - Type UnspecifiedGROUP
ILIL1656Medicare Oscar/Certification
IL036089921Medicaid