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Organization
RAJENDRA R SHROFF MD SC
Active
Organization
RAJENDRA R SHROFF MD SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BRENDA SUE LANCE (OFFICE MANAGER)
(618) 532-5700
Entity
Organization
Contact information
Practice address
1050 M L KING DR STE 101, CENTRALIA, IL 62801-3060
(618) 532-5700
(618) 532-7390
Mailing address
1050 M L KING DR STE 101, CENTRALIA, IL 62801-3060
(618) 532-5700
(618) 532-7390
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006100111
BLUE CROSS
IL
Enumeration date
03/06/2008
Last updated
03/06/2008
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