Provider Demographics
NPI:1306826714
Name:ROSEN, SCOTT LEWIS (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:LEWIS
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2440 RAVINE WAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025
Mailing Address - Country:US
Mailing Address - Phone:847-724-9400
Mailing Address - Fax:847-724-9401
Practice Address - Street 1:2440 RAVINE WAY
Practice Address - Street 2:SUITE 500
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025
Practice Address - Country:US
Practice Address - Phone:847-724-9400
Practice Address - Fax:847-724-9401
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2020-10-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL36057178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1626938OtherBCBS
IL364396691OtherCOMMERICAL INS
ILK33006Medicare PIN