Basic Information
| Provider Information | |||||||||
| NPI: | 1740246040 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROWLAND | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 375 N WALL ST STE P420 | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609013406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159320911 | ||||||||
| FaxNumber: | 8159320631 | ||||||||
| Practice Location | |||||||||
| Address1: | 375 N WALL ST STE P420 | ||||||||
| Address2: | |||||||||
| City: | KANKAKEE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 609013406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8159320911 | ||||||||
| FaxNumber: | 8159320631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 08/29/2019 | ||||||||
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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 | 208600000X | 036076921 | IL | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 036076921 | 05 | IL | MEDICAID | 123451234567 | 01 | IL | HEALTHLINK INC PPO ID | OTHER | 020011942 | 01 | IL | RAILROAD MEDICARE | OTHER | 123451234567 | 01 | IL | PREFERRED ONE ID | OTHER | 276853600 | 01 | IL | OWCP PROVIDER ID | OTHER | 4615036 | 01 | IL | BCBS PROVIDER ID | OTHER |