Provider Demographics
NPI:1306899372
Name:HAWKINS, ROCHELLE L (MD)
Entity type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:L
Last Name:HAWKINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E 93RD ST
Mailing Address - Street 2:STE.441
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60617-3936
Mailing Address - Country:US
Mailing Address - Phone:773-374-3200
Mailing Address - Fax:773-374-3819
Practice Address - Street 1:2315 E 93RD ST
Practice Address - Street 2:STE.441
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60617-3936
Practice Address - Country:US
Practice Address - Phone:773-374-3200
Practice Address - Fax:773-374-3819
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068578207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC42644Medicare UPIN
IL036068578Medicare ID - Type Unspecified