Provider Demographics
NPI:1093766750
Name:ROZANSKI, NEELAM TRIVEDI (DO)
Entity Type:Individual
Prefix:DR
First Name:NEELAM
Middle Name:TRIVEDI
Last Name:ROZANSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:NEELAM
Other - Middle Name:Y
Other - Last Name:TRIVEDI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 443
Mailing Address - Street 2:
Mailing Address - City:BEDFORD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60499-0443
Mailing Address - Country:US
Mailing Address - Phone:773-355-5300
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:8420 W BRYN MAWR AVE STE 300
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631-3436
Practice Address - Country:US
Practice Address - Phone:773-355-5300
Practice Address - Fax:773-714-1229
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI45573207L00000X
IL036107747207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
006806261IOtherHUMANA
WI43506100Medicaid
I02380Medicare UPIN
WI43506100Medicaid