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General NPI Number Information
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NPI Number | 1548449580
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Entity Type | Organization
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Legal Business Name | MARJORIE MINTZ ROSENBAUM MD LLC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 676 N ST CLAIR SUITE 1725
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City | CHICAGO
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State | IL
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Zip | 60611-2974
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Country | US
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Telephone | 312-664-8533
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Fax | 312-664-8860
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Provider Business Mailing Address
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Address Line | 676 N SAINT CLAIR ST SUITE 1725
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-664-8533
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Fax | 312-664-8860
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Authorized Official
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Title or Position | PHYSICIAN OWNER
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Name | DR. MARJORIE MINTZ ROSENBAUM
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Credential | MD
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Telephone | 312-664-8533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036065456
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License Number State | IL
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