Provider Demographics
NPI:1922173012
Name:DIGESTIVE HEALTH ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH ASSOCIATES, P.C.
Other - Org Name:DIGESTIVE HEALTH ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTNICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-725-5950
Mailing Address - Street 1:1715 N DIVISION ST STE A
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3122
Mailing Address - Country:US
Mailing Address - Phone:815-942-1550
Mailing Address - Fax:815-942-8419
Practice Address - Street 1:1715 N DIVISION ST STE A
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3122
Practice Address - Country:US
Practice Address - Phone:815-942-1550
Practice Address - Fax:815-942-8419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCK3761OtherRAILROAD MEDICARE
ILCK3761OtherRAILROAD MEDICARE