Provider Demographics
NPI:1326026030
Name:RHODE, CLARISSA (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:RHODE
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:PO BOX 3853
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61612-3853
Mailing Address - Country:US
Mailing Address - Phone:800-899-5757
Mailing Address - Fax:314-821-1833
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-655-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0866912085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0007222342OtherBLUE CROSS BLUE SHIELD
IL056202OtherHEALTH ALLIANCE
IL370947902OtherTRICARE CHAMPUS
IL036086691-1Medicaid
IL296047OtherHEALTHLINK
IL3533684OtherACR
ILIL0100OtherJOHN DEER
IL300065444OtherRAILROAD MEDICARE