Organization
ROCKFORD INFECTIOUS DISEASE CONSULTANTS, S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SCOTT R HOMANN M.D. (PRESIDENT)
(815) 229-2300
Entity
Organization
Contact information
Practice address
129 PHELPS AVE, ROCKFORD, IL 61108-2453
(815) 229-2300
(815) 229-3909
Mailing address
129 PHELPS AVE, ROCKFORD, IL 61108-2483
(815) 229-2300
(815) 229-3909
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D55136114
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10115123
BCBS GROUP PROVIDER
IL
Enumeration date
05/24/2006
Last updated
11/26/2014
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