Provider Demographics
NPI:1710903331
Name:ROSENZWEIG, BELLA (MD)
Entity Type:Individual
Prefix:DR
First Name:BELLA
Middle Name:
Last Name:ROSENZWEIG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:BELLA
Other - Middle Name:
Other - Last Name:ROZENTSVAYG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6212 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60660
Mailing Address - Country:US
Mailing Address - Phone:773-465-8131
Mailing Address - Fax:773-465-1929
Practice Address - Street 1:6212 N BROADWAY
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60660
Practice Address - Country:US
Practice Address - Phone:773-465-8131
Practice Address - Fax:773-465-1929
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090182207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001632015OtherBLUE CROSS BLUE SHIELD
IL036090182Medicaid
G19241Medicare UPIN
IL036090182Medicaid