Provider Demographics
NPI:1811991383
Name:UBILLUZ, RODRIGO M (MD)
Entity type:Individual
Prefix:DR
First Name:RODRIGO
Middle Name:M
Last Name:UBILLUZ
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 1:4121 FAIRVIEW AVE
Mailing Address - Street 2:204
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-2264
Mailing Address - Country:US
Mailing Address - Phone:630-964-7136
Mailing Address - Fax:773-767-3944
Practice Address - Street 1:4121 FAIRVIEW AVE
Practice Address - Street 2:204
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-2264
Practice Address - Country:US
Practice Address - Phone:630-964-7136
Practice Address - Fax:773-767-3944
Is Sole Proprietor?:No
Enumeration Date:2005-06-12
Last Update Date:2017-03-10
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-31
Provider Licenses
StateLicense IDTaxonomies
IL0360815812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1632454OtherBCBS PROVIDER NUMBER
IL036081581Medicaid
ILE79152Medicare UPIN
IL204012Medicare PIN