Healthcare Provider Details

I. General information

NPI: 1790773216
Provider Name (Legal Business Name): SUELLYN S ROSSMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2434 E DEMPSTER ST STE 206
DES PLAINES IL
60016-5340
US

IV. Provider business mailing address

2434 E DEMPSTER ST STE 206
DES PLAINES IL
60016-5340
US

V. Phone/Fax

Practice location:
  • Phone: 847-297-2474
  • Fax: 847-297-2476
Mailing address:
  • Phone: 847-297-2474
  • Fax: 847-297-2476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number036042529
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: