Provider Demographics
NPI:1326589151
Name:MAXWELL ROVNER, M.D. S.C.
Entity Type:Organization
Organization Name:MAXWELL ROVNER, M.D. S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAXWELL
Authorized Official - Middle Name:RABSON
Authorized Official - Last Name:ROVNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-508-3475
Mailing Address - Street 1:30 N. MICHIGAN AVE.
Mailing Address - Street 2:SUITE 1004
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3750
Mailing Address - Country:US
Mailing Address - Phone:312-508-3475
Mailing Address - Fax:312-275-7955
Practice Address - Street 1:1344 N. DEARBORN PKWY.
Practice Address - Street 2:APT. 13A
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-6061
Practice Address - Country:US
Practice Address - Phone:312-375-3101
Practice Address - Fax:312-664-1625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.1362282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty