Provider Demographics
NPI:1962704965
Name:MARY ANN ROSANOVA-KAPER, M.D., S.C.
Entity type:Organization
Organization Name:MARY ANN ROSANOVA-KAPER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ROSANOVA-KAPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-381-4300
Mailing Address - Street 1:330 EAST MAIN STREET
Mailing Address - Street 2:SUITE 1W
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010
Mailing Address - Country:US
Mailing Address - Phone:847-381-4300
Mailing Address - Fax:847-381-4350
Practice Address - Street 1:330 E MAIN ST
Practice Address - Street 2:SUITE 1W
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3203
Practice Address - Country:US
Practice Address - Phone:847-381-4300
Practice Address - Fax:847-381-4350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36.042248261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042248Medicaid
IL036042248Medicaid
D89159Medicare UPIN