Provider Demographics
NPI:1508972498
Name:MARVIN J ROSSER MD LTD
Entity Type:Organization
Organization Name:MARVIN J ROSSER MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-226-6017
Mailing Address - Street 1:117 S COOK ST
Mailing Address - Street 2:#114
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-4311
Mailing Address - Country:US
Mailing Address - Phone:847-226-6017
Mailing Address - Fax:
Practice Address - Street 1:117 S COOK ST
Practice Address - Street 2:#114
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-4311
Practice Address - Country:US
Practice Address - Phone:847-226-6017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042.006016207W00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
D10180Medicare UPIN
IL243800Medicare ID - Type Unspecified