| Rockland Professional Group Llc | |
|
114 W Rockland Rd Libertyville IL 60048-2774 | |
| (847) 816-9180 | |
| (847) 816-9183 |
| Full Name | Rockland Professional Group Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 114 W Rockland Rd, Libertyville, Illinois |
| Authorized Official Name and Position | Brett A Sisler (OWNER ADMINISTRATOR) |
| Authorized Official Contact | 8478169180 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rockland Professional Group Llc 114 W Rockland Rd Libertyville IL 60048-2774 Ph: (847) 816-9180 | Rockland Professional Group Llc 114 W Rockland Rd Libertyville IL 60048-2774 Ph: (847) 816-9180 |
| NPI Number | 1295897148 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 11/27/2007 |
| Medicare PECOS PAC ID | 8325118516 |
|---|---|
| Medicare Enrollment ID | O20080530000186 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295897148 | NPI | - | NPPES |
| 04920480 | Other | IL | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Brett A Sisler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1609090844 PECOS PAC ID: 9931279122 Enrollment ID: I20120518000469 |
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