Provider Demographics
NPI:1164519054
Name:ROJAS, MANUEL O (MD)
Entity Type:Individual
Prefix:
First Name:MANUEL
Middle Name:O
Last Name:ROJAS
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 1:4254 W 55TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60632
Mailing Address - Country:US
Mailing Address - Phone:773-582-5200
Mailing Address - Fax:773-582-2771
Practice Address - Street 1:4254 W 55TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60632
Practice Address - Country:US
Practice Address - Phone:773-582-5200
Practice Address - Fax:773-582-2771
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360496461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049646Medicaid