Provider Demographics
NPI:1285662304
Name:ROTSKOFF, BRIAN
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:
Last Name:ROTSKOFF
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:
Other - Last Name:ROTSKOFF
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4801 W PETERSON AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60646-5713
Mailing Address - Country:US
Mailing Address - Phone:773-877-3500
Mailing Address - Fax:888-228-2622
Practice Address - Street 1:4801 W PETERSON AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60646-5713
Practice Address - Country:US
Practice Address - Phone:773-877-3500
Practice Address - Fax:888-228-2622
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-102370207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL214887Medicare PIN
ILH36114Medicare UPIN
ILK49734Medicare UPIN