Provider Demographics
NPI:1245277607
Name:RODRIGUEZ FLORIDO, JULIO (SAC)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:
Last Name:RODRIGUEZ FLORIDO
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 GREGORY DR
Mailing Address - Street 2:
Mailing Address - City:ZION
Mailing Address - State:IL
Mailing Address - Zip Code:60099-1345
Mailing Address - Country:US
Mailing Address - Phone:847-731-0627
Mailing Address - Fax:847-731-0627
Practice Address - Street 1:4221 GREGORY DR
Practice Address - Street 2:
Practice Address - City:ZION
Practice Address - State:IL
Practice Address - Zip Code:60099-1345
Practice Address - Country:US
Practice Address - Phone:847-731-0627
Practice Address - Fax:847-731-0627
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL238000091246ZC0007X, 363AS0400X, 246ZC0007X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
0004932660OtherBLUE CROSS BLUE SHIELD OF ILLINOIS