Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | IL036060221 | IL |
Y | 208600000X | Surgeon | IL036060221 | IL |
NPI | 1023080702 |
---|---|
Provider Name | Mary K Rosenow |
First Address | Tunnel Hill, IL 62972-3138 |
Second Address | Tunnel Hill, IL 62972-3138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2006 |
Last Update Date | 24/03/2015 |