Provider Demographics
NPI:1851315949
Name:ROSEN, BARRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 FOX GLN
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-1860
Mailing Address - Country:US
Mailing Address - Phone:847-381-8161
Mailing Address - Fax:847-381-8167
Practice Address - Street 1:802 FOX GLN
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-1860
Practice Address - Country:US
Practice Address - Phone:847-381-8161
Practice Address - Fax:847-381-8167
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360792122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0360792122Medicaid
IL04929950OtherBC BS
IL04929950OtherBC BS
ILL84573Medicare ID - Type Unspecified