Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 036110143 | IL |
NPI | 1053336776 |
---|---|
Provider Name | Joshua Rosenow |
First Address | Chicago, IL 60611-2922 |
Second Address | Chicago, IL 60611-4546 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2006 |
Last Update Date | 29/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036110143 | MEDICAID PTAN (01) | |
206147 | MEDICARE PTAN (GROUP) (01) | IL |
F400156025 | MEDICARE PTAN (INDIVIDUAL) (01) | IL |
H61793 | (02) |