Provider Demographics
NPI:1023277019
Name:ROGELIO O CAVE MD SC
Entity type:Organization
Organization Name:ROGELIO O CAVE MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:ROSITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-846-9521
Mailing Address - Street 1:9526 S KILBOURN AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-3208
Mailing Address - Country:US
Mailing Address - Phone:708-422-3716
Mailing Address - Fax:
Practice Address - Street 1:67 W 111TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60628-4247
Practice Address - Country:US
Practice Address - Phone:773-995-3454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-04
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036050538207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036050538-1Medicaid
IL21624903OtherBLUECROSS BLUE SHIELD OF ILLINOIS
IL111910550OtherRAILROAD MEDICARE
IL477992Medicare PIN
IL111910550OtherRAILROAD MEDICARE