Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036 085338 | IL |
NPI | 1043285026 |
---|---|
Provider Name | Gail L Rosseau |
First Address | Chicago, IL 60640 |
Second Address | Chicago, IL 60640 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 28/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0360853381 | (05) | IL |
F41311 | (02) |