Provider Demographics
NPI:1477529949
Name:PORCELLI, ROSALIA (DO)
Entity Type:Individual
Prefix:
First Name:ROSALIA
Middle Name:
Last Name:PORCELLI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ROSALIA
Other - Middle Name:
Other - Last Name:STARECHESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9977 WOODS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077-1057
Mailing Address - Country:US
Mailing Address - Phone:224-364-2273
Mailing Address - Fax:847-663-8290
Practice Address - Street 1:9977 WOODS DR STE 100
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1057
Practice Address - Country:US
Practice Address - Phone:224-364-2273
Practice Address - Fax:847-663-8290
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36097646208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36097646Medicaid
IL578010Medicare ID - Type Unspecified
H21954Medicare UPIN