Provider Demographics
NPI:1225002348
Name:ROHDE, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:ROHDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2160 S FIRST AVE
Mailing Address - Street 2:(17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181)
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153
Mailing Address - Country:US
Mailing Address - Phone:630-627-7399
Mailing Address - Fax:630-627-7079
Practice Address - Street 1:2160 S FIRST AVE
Practice Address - Street 2:(17W740 22ND STREET, OAKBROOK TERRACE, IL. 60181)
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153
Practice Address - Country:US
Practice Address - Phone:630-627-7399
Practice Address - Fax:630-627-7079
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36091605207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36091605Medicaid
G52149Medicare UPIN