Provider Demographics
NPI:1376909267
Name:ROSCOE INTEGRATED MEDICINE LTD
Entity Type:Organization
Organization Name:ROSCOE INTEGRATED MEDICINE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:KARL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:773-472-1600
Mailing Address - Street 1:2151 W ROSCOE ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-6267
Mailing Address - Country:US
Mailing Address - Phone:773-472-1600
Mailing Address - Fax:773-472-1611
Practice Address - Street 1:2151 W ROSCOE ST STE 1E
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-6267
Practice Address - Country:US
Practice Address - Phone:773-472-1600
Practice Address - Fax:773-472-1611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-07
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty