Provider Demographics
NPI:1528036456
Name:ROSTEIN, DANIEL ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ALBERT
Last Name:ROSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 MIDWEST RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1277
Mailing Address - Country:US
Mailing Address - Phone:630-472-9100
Mailing Address - Fax:630-472-9101
Practice Address - Street 1:2208 MIDWEST RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1277
Practice Address - Country:US
Practice Address - Phone:630-472-9100
Practice Address - Fax:630-472-9101
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-08
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036089441207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036089441Medicaid
ILG81109Medicare UPIN