Provider Demographics
NPI:1174550008
Name:JALILI, ROCKNI (MD)
Entity type:Individual
Prefix:
First Name:ROCKNI
Middle Name:
Last Name:JALILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S COLLIER BLVD
Mailing Address - Street 2:1923
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6433
Mailing Address - Country:US
Mailing Address - Phone:239-389-6564
Mailing Address - Fax:
Practice Address - Street 1:1100 S COLLIER BLVD
Practice Address - Street 2:1923
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-6433
Practice Address - Country:US
Practice Address - Phone:239-389-6564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034422J207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHA84684Medicare UPIN
OHJA0428341Medicare ID - Type UnspecifiedMEDICARE I.D. #