Individual
DR. DERRICK E ROLLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801-2529
(217) 383-3311
(217) 383-3463
Mailing address
611 W PARK ST, BWPC, URBANA, IL 61801-2529
(217) 383-6792
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
036122306
IL
208000000X
Pediatrics Physician
125-051736
IL
2080N0001X
Neonatal-Perinatal Medicine Physician
02004004A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000761884
ANTHEM PROVIDER NUMBER
IN
05
—
201060370
—
IN
Enumeration date
06/28/2007
Last updated
01/19/2021
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