Provider Demographics
NPI:1477694982
Name:FRANKEL, RODDY (MD)
Entity Type:Individual
Prefix:DR
First Name:RODDY
Middle Name:
Last Name:FRANKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 W ILES AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-7015
Mailing Address - Country:US
Mailing Address - Phone:847-404-0039
Mailing Address - Fax:847-551-1240
Practice Address - Street 1:2000 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2623
Practice Address - Country:US
Practice Address - Phone:217-245-6814
Practice Address - Fax:217-245-0375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036098053207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G33040Medicare UPIN
705330Medicare ID - Type Unspecified