Provider Demographics
NPI:1649222316
Name:ROSENBERG, PAUL K (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:K
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18060 PAYSPHERE CIR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60674-0001
Mailing Address - Country:US
Mailing Address - Phone:630-469-9200
Mailing Address - Fax:
Practice Address - Street 1:471 W ARMY TRAIL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-2673
Practice Address - Country:US
Practice Address - Phone:630-980-3366
Practice Address - Fax:630-980-3686
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-060521207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILD15407Medicare UPIN
IL724470Medicare ID - Type UnspecifiedDUPAGE COUNTY
IL200575Medicare ID - Type UnspecifiedCOOK COUNTY