Provider Demographics
NPI:1700960572
Name:GREELING, RODNEY L (DO)
Entity type:Individual
Prefix:MR
First Name:RODNEY
Middle Name:L
Last Name:GREELING
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:1836 LACKLAND HILL PKWY
Mailing Address - Street 2:ATTNT: CREDENTIALING DEPT.
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-3572
Mailing Address - Country:US
Mailing Address - Phone:314-989-0300
Mailing Address - Fax:
Practice Address - Street 1:6812 STATE ROUTE 162
Practice Address - Street 2:STE 21
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-5566
Practice Address - Fax:618-288-4005
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2020-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036083847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036083847002Medicaid
ILK24888Medicare PIN