Provider Demographics
NPI:1295841336
Name:ROSENBERG, LISA F (MD)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:F
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:676 N ST CLAIR
Mailing Address - Street 2:#320
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611
Mailing Address - Country:US
Mailing Address - Phone:312-475-1000
Mailing Address - Fax:312-475-1006
Practice Address - Street 1:676 N ST CLAIR
Practice Address - Street 2:#1500
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-475-1000
Practice Address - Fax:312-475-1006
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
479560Medicare ID - Type Unspecified
E18341Medicare UPIN