Individual
RENATO BACOL RIVERA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9515 HOLY CROSS LN STE 175, BREESE, IL 62230-3618
(618) 526-8430
(618) 526-7275
Mailing address
9401 HOLY CROSS LN, SUITE 111, BREESE, IL 62230-3510
(618) 526-7133
(618) 526-7160
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036045712
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036045712
—
IL
Enumeration date
07/07/2005
Last updated
12/30/2021
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