Provider Demographics
NPI:1942208079
Name:ROSENSON, ANDREW SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:SCOTT
Last Name:ROSENSON
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 1:1901 RAYMOND DR STE 5
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6794
Mailing Address - Country:US
Mailing Address - Phone:847-814-9955
Mailing Address - Fax:855-629-8353
Practice Address - Street 1:1901 RAYMOND DR STE 5
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-6794
Practice Address - Country:US
Practice Address - Phone:847-814-9955
Practice Address - Fax:855-629-8353
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036065616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036065616Medicaid
IL036065616Medicaid