Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 036-068332 | IL |
NPI | 1003891987 |
---|---|
Provider Name | Dr. Michael Perry Rosenbaum |
First Address | Skokie, IL 60077-1057 |
Second Address | Skokie, IL 60077-1057 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2005 |
Last Update Date | 06/10/2020 |