Organization
MARJORIE MINTZ ROSENBAUM MD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARJORIE MINTZ ROSENBAUM MD (PHYSICIAN OWNER)
(312) 664-8533
Entity
Organization
Contact information
Practice address
676 N ST CLAIR, SUITE 1725, CHICAGO, IL 60611-2974
(312) 664-8533
(312) 664-8860
Mailing address
676 N SAINT CLAIR ST, SUITE 1725, CHICAGO, IL 60611-2927
(312) 664-8533
(312) 664-8860
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
036065456
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
204237
MEDICARE GROUP PROVIDER NO.
IL
Enumeration date
10/26/2007
Last updated
10/10/2011
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