Provider Demographics
NPI:1174637227
Name:ROSENBAUM & LEVINE, M.D.,S.C.
Entity Type:Organization
Organization Name:ROSENBAUM & LEVINE, M.D.,S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROSENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-926-3600
Mailing Address - Street 1:676 N SAINT CLAIR ST STE 1745
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2974
Mailing Address - Country:US
Mailing Address - Phone:312-926-3600
Mailing Address - Fax:312-926-3606
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1745
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2974
Practice Address - Country:US
Practice Address - Phone:312-926-3600
Practice Address - Fax:312-926-3606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042003915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21606171OtherBC/BS IL