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NPI Code Detail

MEDICARE: DR. DAVID ROSS MD

MEDICARE: DR. DAVID ROSS MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery PhysicianIL

General Provider Information

NPI Number : 1184817892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID ROSS MD
Provider Business Mailing Address
First Line : 11300 W. 79TH STREET
Second Line :
City : BURR RIDGE
State : IL
Zip : 60527
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 875 N RUSH ST
Second Line :
City : CHICAGO
State : IL
Zip : 60611-2030
Country : US
Telephone Number : 312-266-8765
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2007
Last Update Date : 08/27/2007

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