Individual
MATILDA M ROSANWO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
360 STATION DR, CRYSTAL LAKE, IL 60014
(815) 338-6600
(815) 455-8044
Mailing address
360 STATION DR, CRYSTAL LAKE, IL 60014-7978
(815) 338-6600
(815) 455-8044
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036104686
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036104686
STATE LICENSE
IL
05
—
0361046863
—
IL
01
—
P00424928
RR MEDICARE
IL
Enumeration date
12/29/2005
Last updated
10/22/2018
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us