Provider Demographics
NPI:1104841410
Name:DOLEZAL, RUDOLPH FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:RUDOLPH
Middle Name:FRANK
Last Name:DOLEZAL
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 1:605 W CENTRAL RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2377
Mailing Address - Country:US
Mailing Address - Phone:847-398-8844
Mailing Address - Fax:847-398-8880
Practice Address - Street 1:605 W CENTRAL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2377
Practice Address - Country:US
Practice Address - Phone:847-398-8844
Practice Address - Fax:847-398-8880
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-051849208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL490 1127OtherBCBS PROV.#
IL207703Medicare ID - Type Unspecified
ILA77475Medicare UPIN