Provider Demographics
NPI:1609850981
Name:ROSE, MICHELLE PATRICIA (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PATRICIA
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:PATRICIA
Other - Last Name:ROSE-SKINNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3275 N ARLINGTON HEIGHTS RD STE 409
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-7709
Mailing Address - Country:US
Mailing Address - Phone:224-857-8000
Mailing Address - Fax:224-857-8001
Practice Address - Street 1:3275 N ARLINGTON HEIGHTS RD STE 409
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-7709
Practice Address - Country:US
Practice Address - Phone:224-857-8000
Practice Address - Fax:224-857-8001
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087669208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics