Provider Demographics
NPI:1003817180
Name:ROSENBERG, FRED B (MD)
Entity Type:Individual
Prefix:DR
First Name:FRED
Middle Name:B
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TOWER CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-5711
Mailing Address - Country:US
Mailing Address - Phone:847-244-2960
Mailing Address - Fax:847-244-2986
Practice Address - Street 1:20 TOWER CT
Practice Address - Street 2:SUITE C
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-5711
Practice Address - Country:US
Practice Address - Phone:847-244-2960
Practice Address - Fax:847-244-2986
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-049355207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC44171Medicare UPIN