Basic Information
| Provider Information | |||||||||
| NPI: | 1760596886 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROCK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | H | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1165 N CLARK ST | ||||||||
| Address2: | SUITE 700 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606102702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128096500 | ||||||||
| FaxNumber: | 3128096501 | ||||||||
| Practice Location | |||||||||
| Address1: | 7101 W HIGGINS AVE | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606561903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3128096500 | ||||||||
| FaxNumber: | 3128096501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2006 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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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 | 207L00000X | 036078236 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0014X | 036078236 | IL | Y | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0001620300 | 01 | IL | BLUECROSS BLUESHILD OF IL | OTHER | 036078236 1 | 05 | IL | MEDICAID | 364054341 | 01 | IL | COMMERCIAL INS.GROUP# | OTHER |