Individual
ROSENA CUSTODIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1900 E MAIN ST, DANVILLE, IL 61832-5100
(217) 554-5541
Mailing address
38 BLUE STAR HWY, DANVILLE, IL 61832-6100
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
4301035393
MI
Other
Enumeration date
10/05/2006
Last updated
07/08/2007
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