Healthcare Provider Details

I. General information

NPI: 1588129928
Provider Name (Legal Business Name): ROSETT PLASTIC SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2019
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2461 N CLYBOURN AVE
CHICAGO IL
60614-1942
US

IV. Provider business mailing address

2461 N CLYBOURN AVE
CHICAGO IL
60614-1942
US

V. Phone/Fax

Practice location:
  • Phone: 312-535-2200
  • Fax:
Mailing address:
  • Phone: 312-535-2200
  • Fax: 312-766-0966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN ROSETT
Title or Position: OWNER
Credential: MD
Phone: 312-535-2200