Provider Demographics
NPI:1902833205
Name:ROLLO J NESSET, MD,SC
Entity Type:Organization
Organization Name:ROLLO J NESSET, MD,SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROLLO
Authorized Official - Middle Name:
Authorized Official - Last Name:NESSET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-253-7060
Mailing Address - Street 1:605 W CENTRAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-2377
Mailing Address - Country:US
Mailing Address - Phone:847-253-7060
Mailing Address - Fax:847-253-8086
Practice Address - Street 1:605 W CENTRAL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2377
Practice Address - Country:US
Practice Address - Phone:847-253-7060
Practice Address - Fax:847-253-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36-36901207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1601215OtherBLUE CROSS BLUE SHIELD
IL5922220001Medicare NSC
IL1601215OtherBLUE CROSS BLUE SHIELD
ILC39869Medicare UPIN