MEDICARE: CLEMENT S ROSE MD PC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1861757874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLEMENT S ROSE MD PC

Provider Business Mailing Address
First Line	:	PO BOX 26975
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32226-6975
Country	:	US
Telephone Number	:	904-503-1132
Fax Number	:	888-886-4464

Provider Business Practice Location Address
First Line	:	5025 N PAULINA ST STE 501
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2772
Country	:	US
Telephone Number	:	773-599-4363
Fax Number	:	773-599-4788

Authorized Official
Title or Position	:	CEO
Name	:	DR. CLEMENT S ROSE
Credential	:	MD
Telephone Number	:	773-599-4363

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	01/20/2026

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