Provider Demographics
NPI:1245346485
Name:IOFFE, ROZA (MD)
Entity type:Individual
Prefix:
First Name:ROZA
Middle Name:
Last Name:IOFFE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 HEALTH CENTER DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938
Mailing Address - Country:US
Mailing Address - Phone:217-258-4006
Mailing Address - Fax:217-258-4120
Practice Address - Street 1:1005 HEALTH CENTER DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938
Practice Address - Country:US
Practice Address - Phone:217-258-4006
Practice Address - Fax:217-258-4120
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-069392208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC39796Medicare UPIN
ILP10309Medicare PIN