Provider Demographics
NPI:1487727327
Name:LYNDA RODEN DOSC
Entity type:Organization
Organization Name:LYNDA RODEN DOSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-549-7777
Mailing Address - Street 1:1870 W WINCHESTER RD
Mailing Address - Street 2:STE 143
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5358
Mailing Address - Country:US
Mailing Address - Phone:847-549-7777
Mailing Address - Fax:847-549-7779
Practice Address - Street 1:1870 W WINCHESTER RD
Practice Address - Street 2:STE 143
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5358
Practice Address - Country:US
Practice Address - Phone:847-549-7777
Practice Address - Fax:847-549-7779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-0956476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L79226Medicare ID - Type Unspecified
IL587480Medicare UPIN