Organization
MIDWEST REHABILITATION ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRANCES GULOTTA DEPPE MD (EXECUTIVE)
(815) 741-2201
Entity
Organization
Contact information
Practice address
2400 GLENWOOD AVE, SUITE 120, JOLIET, IL 60435-5474
(815) 741-2201
(815) 741-2285
Mailing address
PO BOX 3997, JOLIET, IL 60434-3997
(815) 741-2201
(815) 741-2285
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09932105
BC/BS
IL
01
—
DA5166
RAIL ROAD MEDICARE
IL
Enumeration date
07/30/2006
Last updated
08/22/2020
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