Provider Demographics
NPI:1497841415
Name:SCOTT L ROSEN MD LTD
Entity Type:Organization
Organization Name:SCOTT L ROSEN MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-724-9400
Mailing Address - Street 1:2440 RAVINE WAY
Mailing Address - Street 2:STE 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:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36057178207W00000X
IL36115629207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1626938OtherBCBS
IL1626938OtherBCBS
IL0000214401Medicare NSC