Provider Demographics
NPI:1285812156
Name:ROSSINOW, JILL K (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:K
Last Name:ROSSINOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5150 N 16TH ST
Mailing Address - Street 2:STE. B232
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3925
Mailing Address - Country:US
Mailing Address - Phone:602-441-0008
Mailing Address - Fax:866-571-0383
Practice Address - Street 1:5150 N 16TH ST
Practice Address - Street 2:STE. B232
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-3925
Practice Address - Country:US
Practice Address - Phone:602-441-0008
Practice Address - Fax:866-571-0383
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2356492085R0001X
AZ420092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ439764Medicaid
AZ1285812156OtherBCBS AZ
AZ439764Medicaid