MEDICARE: DR. JAY H ROSENBERG M.D.

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
1	173000000X	Legal Medicine	036-043925	IL
2	174400000X	Specialist	036043925	IL
3	208200000X	Plastic Surgery Physician	036043925	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760556229
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY H ROSENBERG M.D.

Provider Business Mailing Address
First Line	:	350 S 8TH ST
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-2248
Country	:	US
Telephone Number	:	847-836-3200
Fax Number	:	847-836-3204

Provider Business Practice Location Address
First Line	:	350 S 8TH ST
Second Line	:
City	:	WEST DUNDEE
State	:	IL
Zip	:	60118-2248
Country	:	US
Telephone Number	:	847-836-3200
Fax Number	:	847-836-3204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	11/13/2019

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