Provider Demographics
NPI:1427128909
Name:ALFORD, RODNEY (MD)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:
Last Name:ALFORD
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 1:200E FAIRMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WATSEKA
Mailing Address - State:IL
Mailing Address - Zip Code:60970-1644
Mailing Address - Country:US
Mailing Address - Phone:815-432-5841
Mailing Address - Fax:
Practice Address - Street 1:401 N WALL ST
Practice Address - Street 2:SUITE 206
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2934
Practice Address - Country:US
Practice Address - Phone:815-937-2044
Practice Address - Fax:815-937-2029
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036068108208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036068108Medicaid
ILF400228048OtherMEDICARE ID IROQUOIS MEMORIAL HOSPITAL
ILF400228052OtherMEDICARE ID IMH MULTISPECIALTY PHYSICIANS
IL036068108Medicaid