Healthcare Provider Details

I. General information

NPI: 1689133951
Provider Name (Legal Business Name): ANTHONY MICHAEL ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2019
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5115 N FRANCISCO AVE
CHICAGO IL
60625-3611
US

IV. Provider business mailing address

5115 N FRANCISCO AVE
CHICAGO IL
60625-3611
US

V. Phone/Fax

Practice location:
  • Phone: 847-857-0425
  • Fax: 847-933-3520
Mailing address:
  • Phone: 847-857-0425
  • Fax: 847-933-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number036171486
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number036171486
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: