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General NPI Number Information
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NPI Number | 1083052609
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Entity Type | Organization
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Legal Business Name | CHICAGO AGE MANAGEMENT INSTITUTE
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Dates
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Enumeration Date | 06/05/2013
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Last Update Date | 06/05/2013
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Provider Practice Location Address
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Address Line | 60 REVERE DR STE 820
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City | NORTHBROOK
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State | IL
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Zip | 60062-1580
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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 | 60 REVERE DR STE 820
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City | NORTHBROOK
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State | IL
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Zip | 60062-1580
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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 | CHIEF MEDICAL OFFICER, CEO
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Name | MRAK ROSENBLOOM
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Credential | MD
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Telephone | 847-905-9505
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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 |
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License Number State |
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