Provider Demographics
NPI:1992942130
Name:STEVEN D ROSENBERG DR
Entity type:Organization
Organization Name:STEVEN D ROSENBERG DR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-267-2133
Mailing Address - Street 1:1719 E AZTEC LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PROSPECT
Mailing Address - State:IL
Mailing Address - Zip Code:60056-1636
Mailing Address - Country:US
Mailing Address - Phone:773-267-2133
Mailing Address - Fax:773-282-7389
Practice Address - Street 1:1719 E AZTEC LN
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-1636
Practice Address - Country:US
Practice Address - Phone:773-267-2133
Practice Address - Fax:773-282-7389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-09
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
4613760001Medicare NSC