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General NPI Number Information
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NPI Number | 1639277114
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Entity Type | Organization
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Legal Business Name | ENRICA ROSSI MD SC CORPORATION
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/28/2014
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Provider Practice Location Address
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Address Line | 1044 N FRANCISCO AVE
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City | CHICAGO
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State | IL
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Zip | 60622-2743
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Country | US
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Telephone | 312-371-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 333 W NORTH AVE #290
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City | CHICAGO
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State | IL
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Zip | 60610-1293
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Country | US
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Telephone | 312-371-3588
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ENRICA ROSSI
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Credential |
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Telephone | 312-371-3588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036095803
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License Number State | IL
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