Provider Demographics
NPI:1710329271
Name:ROLENS, JOSEPH P (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:P
Last Name:ROLENS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 CLOCK TOWER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62704-1383
Mailing Address - Country:US
Mailing Address - Phone:217-787-7513
Mailing Address - Fax:
Practice Address - Street 1:1001 CLOCK TOWER DR
Practice Address - Street 2:SUITE A
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62704-1383
Practice Address - Country:US
Practice Address - Phone:217-787-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016.005708213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist