Provider Demographics
NPI:1932119112
Name:ROLLET, JOHN C (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:ROLLET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E PLUMMER BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:IL
Mailing Address - Zip Code:62629-8136
Mailing Address - Country:US
Mailing Address - Phone:217-483-3333
Mailing Address - Fax:217-483-4393
Practice Address - Street 1:125 E PLUMMER BLVD STE A
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:IL
Practice Address - Zip Code:62629-8136
Practice Address - Country:US
Practice Address - Phone:217-483-3333
Practice Address - Fax:217-483-4393
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036064761207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00149037OtherRR MEDICARE PIN
IL036064761OtherIL STATE LICENSE
IL14D0435365OtherCLIA
IL133586700OtherACS-OWCP
IL08421024OtherBC/BS
IL222697OtherPERSONAL CARE
IL036064761Medicaid
IL100940OtherHEALTHLINK
IL6394POtherCATERPILLAR
ILCD7143OtherRR MEDICARE GROUP
IL008540OtherHEALTH ALLIANCE
IL020057300OtherBLACK LUNG
ILP00149037OtherRR MEDICARE PIN