Provider Demographics
NPI:1013201375
Name:DAISY, EMMA RODEWALD (MD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:RODEWALD
Last Name:DAISY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:CATHERINE
Other - Last Name:RODEWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 W DEVON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660-1302
Mailing Address - Country:US
Mailing Address - Phone:773-751-7850
Mailing Address - Fax:
Practice Address - Street 1:1300 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660-1302
Practice Address - Country:US
Practice Address - Phone:773-751-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.134839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine