Provider Demographics
NPI:1235136268
Name:WOODS, RITA (MD)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:
Last Name:WOODS
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 1:10844 187TH ST
Mailing Address - Street 2:
Mailing Address - City:MOKENA
Mailing Address - State:IL
Mailing Address - Zip Code:60448-7759
Mailing Address - Country:US
Mailing Address - Phone:708-326-6270
Mailing Address - Fax:708-995-5417
Practice Address - Street 1:10844 187TH ST
Practice Address - Street 2:
Practice Address - City:MOKENA
Practice Address - State:IL
Practice Address - Zip Code:60448-7759
Practice Address - Country:US
Practice Address - Phone:708-326-6270
Practice Address - Fax:708-995-5417
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036070390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL336-034285Medicaid
IL497610/L69210Medicare ID - Type UnspecifiedGROUP#/PROV#
IL336-034285Medicaid