Provider Demographics
NPI:1801900949
Name:ROSENBAUM, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:ROSENBAUM
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 1:676 N SAINT CLAIR ST STE 1745
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-2974
Mailing Address - Country:US
Mailing Address - Phone:312-926-3600
Mailing Address - Fax:855-205-7749
Practice Address - Street 1:676 N SAINT CLAIR ST STE 1745
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2974
Practice Address - Country:US
Practice Address - Phone:312-926-3600
Practice Address - Fax:855-205-7749
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36049095207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDI12789Medicare UPIN
IL479030Medicare ID - Type Unspecified