Provider Demographics
NPI:1528198884
Name:RONDELLI, DAMIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:DAMIANO
Middle Name:
Last Name:RONDELLI
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 1:200 W ADAMS ST
Mailing Address - Street 2:SUITE 225
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-5208
Mailing Address - Country:US
Mailing Address - Phone:312-704-2885
Mailing Address - Fax:312-704-2737
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:DEPT 3462
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:312-704-2885
Practice Address - Fax:312-704-2737
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL95281Medicare ID - Type UnspecifiedUIC GROUP 927060
ILH76183Medicare UPIN