Provider Demographics
NPI:1447459540
Name:THOMAS ROHDE, M.D., LTD
Entity type:Organization
Organization Name:THOMAS ROHDE, M.D., LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROHDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-864-2700
Mailing Address - Street 1:3798 E FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-5053
Mailing Address - Country:US
Mailing Address - Phone:217-864-2700
Mailing Address - Fax:217-864-3930
Practice Address - Street 1:3798 E FULTON AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-5053
Practice Address - Country:US
Practice Address - Phone:217-864-2700
Practice Address - Fax:217-864-3930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-17
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036081038261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILE81713Medicare UPIN