=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013111541
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STREAMWOOD FAMILY MEDICINE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 572 S BARTLETT RD
-----------------------------------------------------
City | STREAMWOOD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60107-1362
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-736-8500
-----------------------------------------------------
Fax | 630-736-8593
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5510 W MONTROSE AVE
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60641-1330
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-282-4700
-----------------------------------------------------
Fax | 773-282-4728
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ALBERT R ROSANOVA JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 630-736-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 36042670
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | 36042670
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------