Provider Demographics
NPI:1235379678
Name:FARRALES, RODRIGO LIM JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:LIM
Last Name:FARRALES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RODRIGO
Other - Middle Name:L
Other - Last Name:FARRALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:435 WILLIAM STREET
Mailing Address - Street 2:UNIT 702
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-1990
Mailing Address - Country:US
Mailing Address - Phone:708-771-3331
Mailing Address - Fax:
Practice Address - Street 1:435 WILLIAM ST
Practice Address - Street 2:UNIT 702
Practice Address - City:RIVER FOREST
Practice Address - State:IL
Practice Address - Zip Code:60305-1984
Practice Address - Country:US
Practice Address - Phone:708-771-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-0524872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052487Medicaid