Provider Demographics
NPI:1790448512
Name:MAXWELL MEDICAL GROUP, SC
Entity Type:Organization
Organization Name:MAXWELL MEDICAL GROUP, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-814-9955
Mailing Address - Street 1:4336 WEST ENFIELD
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 RAYMOND DR.
Practice Address - Street 2:SUITE 5
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:855-629-8353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile