Provider Demographics
NPI: | 1477856540 |
---|---|
Name: | KARLYN ROSENSTIEL |
Entity Type: | Organization |
Organization Name: | KARLYN ROSENSTIEL |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DOCTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | KARLYN |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | ROSENSTIEL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DPM |
Authorized Official - Phone: | 773-531-0043 |
Mailing Address - Street 1: | 1014 CENTRAL AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | DEERFIELD |
Mailing Address - State: | IL |
Mailing Address - Zip Code: | 60015-4215 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 773-531-0043 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1014 CENTRAL AVE |
Practice Address - Street 2: | |
Practice Address - City: | DEERFIELD |
Practice Address - State: | IL |
Practice Address - Zip Code: | 60015-4215 |
Practice Address - Country: | US |
Practice Address - Phone: | 773-531-0043 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-12-13 |
Last Update Date: | 2010-12-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 016005317 | 213ES0103X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 213ES0103X | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery | Group - Single Specialty |