Healthcare Provider Details

I. General information

NPI: 1508283722
Provider Name (Legal Business Name): JEFFREY ROSENBLATT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JEFF ROSENBLATT D.O.

II. Dates (important events)

Enumeration Date: 03/26/2014
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5359 W FULLERTON AVE
CHICAGO IL
60639-1450
US

IV. Provider business mailing address

240 E HURON ST MCGAW PAVILLON SUITE 1-200
CHICAGO IL
60611-2909
US

V. Phone/Fax

Practice location:
  • Phone: 773-836-2785
  • Fax: 773-836-7381
Mailing address:
  • Phone: 312-503-7975
  • Fax: 312-503-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number036.142230
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: