Provider Demographics
NPI:1114342045
Name:ROTONDI, COURTNEY M
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:M
Last Name:ROTONDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 KEYSTONE CT
Mailing Address - Street 2:
Mailing Address - City:ROLLING MEADOWS
Mailing Address - State:IL
Mailing Address - Zip Code:60008-3811
Mailing Address - Country:US
Mailing Address - Phone:847-392-5440
Mailing Address - Fax:847-385-0294
Practice Address - Street 1:5301 KEYSTONE CT
Practice Address - Street 2:
Practice Address - City:ROLLING MEADOWS
Practice Address - State:IL
Practice Address - Zip Code:60008-3811
Practice Address - Country:US
Practice Address - Phone:847-392-5440
Practice Address - Fax:847-385-0294
Is Sole Proprietor?:No
Enumeration Date:2014-03-01
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.004871363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant