Provider Demographics
NPI:1881879088
Name:ROCKFORD PEDIATRIC PULMONOLOGY, LTD.
Entity type:Organization
Organization Name:ROCKFORD PEDIATRIC PULMONOLOGY, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHOBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-636-7111
Mailing Address - Street 1:7144 KLECKNER RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-6821
Mailing Address - Country:US
Mailing Address - Phone:815-636-7111
Mailing Address - Fax:815-639-3526
Practice Address - Street 1:7144 KLECKNER RD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-6821
Practice Address - Country:US
Practice Address - Phone:815-636-7111
Practice Address - Fax:815-639-3526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-07
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric PulmonologyGroup - Single Specialty