Provider Demographics
NPI:1275529091
Name:ROSSI, MARVIN A (MD PHD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:A
Last Name:ROSSI
Suffix:
Gender:M
Credentials:MD PHD
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Mailing Address - Street 1:1653 W CONGRESS PKWY
Mailing Address - Street 2:# 348 MURDOCK UNIVERSITY NEUROLOGISTS RUMC
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3833
Mailing Address - Country:US
Mailing Address - Phone:312-942-5939
Mailing Address - Fax:312-924-2238
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:# 1106 UNIVERSITY NEUROLOGISTS RUMC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-4500
Practice Address - Fax:312-942-2380
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
IL0361060252084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036106025Medicaid
IL336068434OtherCT SUBSTANCE IL DEPT OF P
BR8031988OtherDEA FED DRUG ENF AGENCY
IL398520L95780Medicare ID - Type Unspecified
BR8031988OtherDEA FED DRUG ENF AGENCY