Provider Demographics
NPI:1194814871
Name:GO, ROLANDO FABI (MD)
Entity type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:FABI
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 SOLUTIONS CENTER
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1004
Mailing Address - Country:US
Mailing Address - Phone:513-421-3504
Mailing Address - Fax:513-231-7055
Practice Address - Street 1:2055 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 235
Practice Address - City:BATAVIA
Practice Address - State:OH
Practice Address - Zip Code:45103
Practice Address - Country:US
Practice Address - Phone:513-732-3100
Practice Address - Fax:513-732-1939
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-3367207Y00000X
OH35-043367207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0399224Medicaid
OH2006993Medicaid
OH9290111Medicare ID - Type UnspecifiedGROUP NUMBER
OH2006993Medicaid
OHA78887Medicare UPIN
OH0399224Medicaid