Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | 036054018 | IL |
NPI | 1104815596 |
---|---|
Provider Name | David R Rosi |
First Address | Chicago, IL 60673-0001 |
Second Address | Melrose Park, IL 60160-1612 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 15/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036054018 | (05) | IL |
C43078 | (02) | IL |