Basic Information
| Provider Information | |||||||||
| NPI: | 1043327927 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODBY | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1426 W WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606071821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128291424 | ||||||||
| FaxNumber: | 3128508431 | ||||||||
| Practice Location | |||||||||
| Address1: | 1426 W WASHINGTON BLVD | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606071821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128291424 | ||||||||
| FaxNumber: | 3128508431 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 09/25/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | 036070596 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 01615381 | 01 | IL | BC/BS ID NUMBER | OTHER | 036070596 | 05 | IL | MEDICAID | 110042308 | 01 | GA | RR MEDICARE | OTHER |