Provider Demographics
NPI:1720301690
Name:ROZOVSKY, ITAI (MD)
Entity Type:Individual
Prefix:DR
First Name:ITAI
Middle Name:
Last Name:ROZOVSKY
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 1:113 MCHENRY RD STE 240
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1796
Mailing Address - Country:US
Mailing Address - Phone:224-770-1503
Mailing Address - Fax:609-739-8440
Practice Address - Street 1:113 MCHENRY RD STE 240
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1796
Practice Address - Country:US
Practice Address - Phone:224-770-1503
Practice Address - Fax:609-739-8440
Is Sole Proprietor?:No
Enumeration Date:2010-03-08
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD035598E207Q00000X
IL0360832292083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102603212Medicaid
PA102603212Medicaid