Healthcare Provider Details

I. General information

NPI: 1942306758
Provider Name (Legal Business Name): ROSENTHAL CLINIC SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S MICHIGAN AVE SUITE 1770
CHICAGO IL
60603
US

IV. Provider business mailing address

122 S MICHIGAN AVE SUITE 1770
CHICAGO IL
60603
US

V. Phone/Fax

Practice location:
  • Phone: 312-939-4121
  • Fax: 312-939-8011
Mailing address:
  • Phone: 312-939-4121
  • Fax: 312-939-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. BONITA M PEREZ
Title or Position: INSURANCE MANAGER
Credential:
Phone: 312-939-4121