Provider Demographics
NPI:1013186840
Name:ROSELIA HERRERA MD SC
Entity Type:Organization
Organization Name:ROSELIA HERRERA MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROSELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-652-0056
Mailing Address - Street 1:6039 W CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:CICERO
Mailing Address - State:IL
Mailing Address - Zip Code:60804-2021
Mailing Address - Country:US
Mailing Address - Phone:708-652-0056
Mailing Address - Fax:
Practice Address - Street 1:6039 W CERMAK RD
Practice Address - Street 2:
Practice Address - City:CICERO
Practice Address - State:IL
Practice Address - Zip Code:60804-2021
Practice Address - Country:US
Practice Address - Phone:708-652-0056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036105062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036105062Medicaid
IL01633515OtherBLUE CROSS BLUE SHIELD
IL036105062Medicaid
IL036105062Medicaid
IL207167Medicare PIN