Provider Demographics
NPI:1003122730
Name:ROSENBLOOM, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:ROSENBLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:60 REVERE DR
Mailing Address - Street 2:SUITE 820
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1563
Mailing Address - Country:US
Mailing Address - Phone:847-905-9505
Mailing Address - Fax:847-905-7344
Practice Address - Street 1:60 REVERE DR
Practice Address - Street 2:SUITE 820
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1563
Practice Address - Country:US
Practice Address - Phone:847-905-9505
Practice Address - Fax:847-905-7344
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-18
Last Update Date:2013-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL0360850532083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine