Individual ProviderRodrigo SandovalEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address1901 W Harrison St, Chicago, IL 60612-3714(312) 864-6000PECOS EnrollmentBased on the most recent information from CMS, provider Rodrigo Sandoval is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 6:04 PM.Profile DetailsProvider ID1588302681Provider TypeIndividualFull NameSandoval, RodrigoTitleDr.CredentialMDGenderMaleSole ProprietorNoEnumeration Date5/26/2022Last Updated5/26/2022Contact InformationPractice LocationPractice Address1901 W Harrison St, Chicago, IL 60612-3714Phone(312) 864-6000FaxUnlisted FaxMailing LocationMailing Address1901 W Harrison St, Chicago, IL 60612-3714Phone(312) 864-6000FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense125.079842Illinois