Provider Demographics
NPI:1558788539
Name:SILLER DE LA ROSA, RICARDO ANDRES (MD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:ANDRES
Last Name:SILLER DE LA ROSA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICARDO
Other - Middle Name:ANDRES
Other - Last Name:SILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2929 CALIFORNIA PLZ APT 7123
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68131-1590
Mailing Address - Country:US
Mailing Address - Phone:956-322-1401
Mailing Address - Fax:
Practice Address - Street 1:305 W JACKSON ST STE 206
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-1474
Practice Address - Country:US
Practice Address - Phone:618-457-3006
Practice Address - Fax:618-457-3007
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL1558788539208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXBP10061730OtherMEDICAL LICENSE