Organization
ROLAND A. TOLLIVER
Active
Other names
Freeport Podiatry Services, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROLAND A TOLLIVER JR. D.P.M. (MEMBER)
(815) 232-8015
Entity
Organization
Contact information
Practice address
1201 W EMPIRE ST, FREEPORT, IL 61032-6106
(815) 232-8015
(815) 235-1376
Mailing address
1201 W EMPIRE ST, FREEPORT, IL 61032-6106
(815) 232-8015
(815) 235-1376
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
016003850
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0060201289
BLUE CROSS BLUE SHIELD
IL
05
—
016003850
—
IL
Enumeration date
10/24/2007
Last updated
06/12/2008
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