Healthcare Provider Details

I. General information

NPI: 1942208079
Provider Name (Legal Business Name): ANDREW SCOTT ROSENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 03/29/2025
Certification Date: 03/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 RAYMOND DR STE 5
NORTHBROOK IL
60062-6794
US

IV. Provider business mailing address

1901 RAYMOND DR STE 5
NORTHBROOK IL
60062-6794
US

V. Phone/Fax

Practice location:
  • Phone: 847-814-9955
  • Fax: 855-629-8353
Mailing address:
  • Phone: 847-814-9955
  • Fax: 855-629-8353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number036065616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: