Provider Demographics
NPI:1912059064
Name:ROSEN MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:ROSEN MEDICAL GROUP, LLC
Other - Org Name:LIFEWEIGH BARIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-261-9393
Mailing Address - Street 1:2801 FINLEY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1038
Mailing Address - Country:US
Mailing Address - Phone:630-261-9393
Mailing Address - Fax:630-261-9335
Practice Address - Street 1:2801 FINLEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1038
Practice Address - Country:US
Practice Address - Phone:630-261-9393
Practice Address - Fax:630-261-9335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty