Provider Demographics
NPI:1649271685
Name:RWR MEDICAL ARTS SC
Entity type:Organization
Organization Name:RWR MEDICAL ARTS SC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-544-7050
Mailing Address - Street 1:1002 N ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:ROBINSON
Mailing Address - State:IL
Mailing Address - Zip Code:62454-1167
Mailing Address - Country:US
Mailing Address - Phone:618-544-7050
Mailing Address - Fax:618-544-3738
Practice Address - Street 1:1002 N ALLEN ST
Practice Address - Street 2:
Practice Address - City:ROBINSON
Practice Address - State:IL
Practice Address - Zip Code:62454-1167
Practice Address - Country:US
Practice Address - Phone:618-544-7050
Practice Address - Fax:618-544-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-01
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036081314Medicaid
ILL023973OtherTRICARE/CHAMPUS
IL080119162OtherPALMENTO GBA MEDICARE
IL170047OtherBC/BS OF IL
IL170047OtherBC/BS OF IL
IL036081314Medicaid