Healthcare Provider Details

I. General information

NPI: 1275529091
Provider Name (Legal Business Name): MARVIN A ROSSI MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST # 1106 UNIVERSITY NEUROLOGISTS RUMC
CHICAGO IL
60612-3841
US

IV. Provider business mailing address

1653 W CONGRESS PKWY # 348 MURDOCK UNIVERSITY NEUROLOGISTS RUMC
CHICAGO IL
60612-3833
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-4500
  • Fax: 312-942-2380
Mailing address:
  • Phone: 312-942-5939
  • Fax: 312-924-2238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036106025
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: