Provider Demographics
NPI:1215466222
Name:ROSENWINKEL, JEFFREY KENNETH (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:KENNETH
Last Name:ROSENWINKEL
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 1:29373 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1293
Mailing Address - Country:US
Mailing Address - Phone:847-390-5900
Mailing Address - Fax:
Practice Address - Street 1:27655 ILLINOIS ROUTE 120
Practice Address - Street 2:
Practice Address - City:LAKEMOOR
Practice Address - State:IL
Practice Address - Zip Code:60051
Practice Address - Country:US
Practice Address - Phone:815-458-1500
Practice Address - Fax:815-458-1501
Is Sole Proprietor?:No
Enumeration Date:2017-06-05
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01084381A207Q00000X
390200000X
IL036171070207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300040921Medicaid
IN000001412093OtherBCBS
IN000001412099OtherBCBS
IN000001409205OtherBCBS
IN000001409701OtherBCBS
IN000001410722OtherBCBS
IN300040921Medicaid
IN000001412110OtherBCBS