Provider Demographics
NPI:1962675876
Name:BELLA ROSENZWEIG MD SC
Entity Type:Organization
Organization Name:BELLA ROSENZWEIG MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENZWEIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-465-8131
Mailing Address - Street 1:6212 N BROADWAY STREET
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 STREET
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELLA ROSENZWEIG MD SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
242189OtherWELLCARE
1632015OtherBLUE CROSS BLUE SHIELD
6057912001OtherCIGNA
6057912001OtherCIGNA
G19241Medicare UPIN