Healthcare Provider Details

I. General information

NPI: 1639372410
Provider Name (Legal Business Name): ALBERT R ROSANOVA JR LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5510 W MONTROSE AVE
CHICAGO IL
60641-1330
US

IV. Provider business mailing address

5510 W MONTROSE AVE
CHICAGO IL
60641-1330
US

V. Phone/Fax

Practice location:
  • Phone: 773-282-4700
  • Fax: 773-282-4728
Mailing address:
  • Phone: 773-282-4700
  • Fax: 773-282-4728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number36042670
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36042670
License Number StateIL

VIII. Authorized Official

Name: DR. ALBERT R ROSANOVA JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 773-282-4700