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General NPI Number Information
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NPI Number | 1003122730
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Entity Type | Individual
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Provider Name | MARK ROSENBLOOM M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 10/24/2025
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Provider Practice Location Address
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Address Line | 1 NORTHFIELD PLZ STE 470
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City | NORTHFIELD
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State | IL
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Zip | 60093-1276
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Country | US
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Telephone | 847-905-9505
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Fax | 847-905-7344
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Provider Business Mailing Address
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Address Line | 1 NORTHFIELD PLZ STE 470
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City | NORTHFIELD
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State | IL
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Zip | 60093-1276
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Country | US
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Telephone | 847-905-9505
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Fax | 847-905-7344
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | 036085053
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License Number State | IL
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