Provider Demographics
NPI:1689790008
Name:RODEN, LYNDA (DOSC)
Entity Type:Individual
Prefix:
First Name:LYNDA
Middle Name:
Last Name:RODEN
Suffix:
Gender:F
Credentials:DOSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 W WINCHESTER RD
Mailing Address - Street 2:STE 143
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5358
Mailing Address - Country:US
Mailing Address - Phone:847-549-7777
Mailing Address - Fax:847-549-7779
Practice Address - Street 1:1870 W WINCHESTER RD
Practice Address - Street 2:STE 143
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5358
Practice Address - Country:US
Practice Address - Phone:847-549-7777
Practice Address - Fax:847-549-7779
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-098545207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL587480Medicare ID - Type Unspecified
ILG84092Medicare UPIN