Provider Demographics
NPI:1548383722
Name:GREGORIO ROSENSTEIN, M.D.
Entity Type:Organization
Organization Name:GREGORIO ROSENSTEIN, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORIO
Authorized Official - Middle Name:GUSTAVO
Authorized Official - Last Name:ROSENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-767-4359
Mailing Address - Street 1:5635 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60629-4438
Mailing Address - Country:US
Mailing Address - Phone:773-767-4359
Mailing Address - Fax:773-767-4369
Practice Address - Street 1:5635 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60629-4438
Practice Address - Country:US
Practice Address - Phone:773-767-4359
Practice Address - Fax:773-767-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF27466Medicare UPIN
IL578540Medicare ID - Type Unspecified