Provider Demographics
NPI:1710085535
Name:SY, RHODORA A (MD)
Entity Type:Individual
Prefix:MRS
First Name:RHODORA
Middle Name:A
Last Name:SY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:RHODORA
Other - Middle Name:A
Other - Last Name:REBADIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:501 S LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:MANTENO
Mailing Address - State:IL
Mailing Address - Zip Code:60950-1654
Mailing Address - Country:US
Mailing Address - Phone:815-468-6737
Mailing Address - Fax:
Practice Address - Street 1:501 S LOCUST ST
Practice Address - Street 2:
Practice Address - City:MANTENO
Practice Address - State:IL
Practice Address - Zip Code:60950-1656
Practice Address - Country:US
Practice Address - Phone:815-468-6737
Practice Address - Fax:815-468-2648
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036095020Medicaid
ILL75208Medicare ID - Type Unspecified
IL036095020Medicaid