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General NPI Number Information
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NPI Number | 1962704965
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Entity Type | Organization
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Legal Business Name | MARY ANN ROSANOVA-KAPER, M.D., S.C.
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 330 E MAIN ST SUITE 1W
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City | BARRINGTON
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State | IL
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Zip | 60010-3203
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Country | US
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Telephone | 847-381-4300
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Fax | 847-381-4350
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Provider Business Mailing Address
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Address Line | 330 EAST MAIN STREET SUITE 1W
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City | BARRINGTON
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State | IL
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Zip | 60010
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Country | US
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Telephone | 847-381-4300
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Fax | 847-381-4350
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Authorized Official
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Title or Position | OWNER
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Name | DR. MARY ANN ROSANOVA-KAPER
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Credential | M.D.
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Telephone | 847-381-4300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 36.042248
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License Number State | IL
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