Provider Demographics
NPI:1609984830
Name:ROCK, RICHARD S (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:S
Last Name:ROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2101 WAUKEGAN RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BANNOCKBURN
Mailing Address - State:IL
Mailing Address - Zip Code:60015-1836
Mailing Address - Country:US
Mailing Address - Phone:847-295-0584
Mailing Address - Fax:847-295-0637
Practice Address - Street 1:2101 WAUKEGAN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BANNOCKBURN
Practice Address - State:IL
Practice Address - Zip Code:60015-1836
Practice Address - Country:US
Practice Address - Phone:847-295-0584
Practice Address - Fax:847-295-0637
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL0360569624207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36059624Medicaid
IL36059624Medicaid
ILC37543Medicare UPIN