Healthcare Provider Details

I. General information

NPI: 1508972498
Provider Name (Legal Business Name): MARVIN J ROSSER MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S COOK ST #114
BARRINGTON IL
60010-4311
US

IV. Provider business mailing address

117 S COOK ST #114
BARRINGTON IL
60010-4311
US

V. Phone/Fax

Practice location:
  • Phone: 847-226-6017
  • Fax:
Mailing address:
  • Phone: 847-226-6017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number042.006016
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number042.006016
License Number StateIL

VIII. Authorized Official

Name: DR. MARVIN J ROSSER
Title or Position: PRESIDENT
Credential: MD
Phone: 847-226-6017