Active NPI
Gloria M Rosenthal
- Driver
- Kankakee, IL
National Provider Identifier
1548636772
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- R25316054101
- Practice address
- 411 S Lincoln Ave
Kankakee, IL 60901-5529 - Phone
- (815) 939-7911
- NPI assigned
- Aug 11, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | R25329365864 | IL | |
| Driver | 172A00000X | R25316054101 | IL | Primary |
Addresses
Primary practice location
411 S Lincoln Ave
Kankakee, IL 60901-5529
Mailing address
411 S Lincoln Ave
Kankakee, IL 60901-5529
Phone (815) 939-7911
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R25316054101 | IL | MD | Driver |
| R25329365864 | IL | MD | Driver |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1439251200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1439251200000",
"number": "1548636772",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "411 S LINCOLN AVE",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609015529",
"telephone_number": "815-939-7911"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 S LINCOLN AVE",
"city": "KANKAKEE",
"state": "IL",
"postal_code": "609015529",
"telephone_number": "815-939-7911"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSENTHAL",
"first_name": "GLORIA",
"middle_name": "M",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-08-11",
"last_updated": "2015-08-11",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "IL",
"license": "R25329365864",
"primary": false
},
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "IL",
"license": "R25316054101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kankakee, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.