Provider Demographics
NPI:1265436695
Name:ROSENBERG, NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:
Last Name:ROSENBERG
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 1:5600 W ADDISON ST STE 503
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60634-4466
Mailing Address - Country:US
Mailing Address - Phone:773-283-8664
Mailing Address - Fax:
Practice Address - Street 1:5600 W ADDISON ST STE 503
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60634-4466
Practice Address - Country:US
Practice Address - Phone:773-283-8664
Practice Address - Fax:773-283-8688
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2022-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36060137207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0336024717OtherCONTROLLED SUBSTANCE
IL36060137Medicaid
IL0336024717OtherCONTROLLED SUBSTANCE
ILC46037Medicare UPIN
ILL76707Medicare PIN