Healthcare Provider Details

I. General information

NPI: 1295841336
Provider Name (Legal Business Name): LISA F ROSENBERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 03/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

676 N ST CLAIR #1500
CHICAGO IL
60611
US

IV. Provider business mailing address

676 N ST CLAIR #320
CHICAGO IL
60611
US

V. Phone/Fax

Practice location:
  • Phone: 312-475-1000
  • Fax: 312-475-1006
Mailing address:
  • Phone: 312-475-1000
  • Fax: 312-475-1006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036072178
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: