Provider Demographics
NPI:1841369881
Name:ROSAS, MARIO C (MD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:C
Last Name:ROSAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2619 S LAWNDALE AVE
Mailing Address - Street 2:FRONT
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60623-4520
Mailing Address - Country:US
Mailing Address - Phone:773-522-2620
Mailing Address - Fax:773-522-2641
Practice Address - Street 1:2619 S LAWNDALE AVE
Practice Address - Street 2:FRONT
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4520
Practice Address - Country:US
Practice Address - Phone:773-522-2620
Practice Address - Fax:773-522-2641
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2018-09-28
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Provider Licenses
StateLicense IDTaxonomies
IL036074065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL931990Medicare PIN