Individual
DR. RITA VIDA ODEGAARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
2160 SOUTH FIRST AVENUE, MAYWOOD, IL 60153
(708) 216-3926
Mailing address
3756 KING WILLIAMS CT, ST CHARLES, IL 60174-7806
(630) 762-8834
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-089815
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
L62699
PIN
IL
Enumeration date
07/03/2006
Last updated
03/31/2015
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