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General NPI Number Information
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NPI Number | 1982945838
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Entity Type | Organization
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Legal Business Name | PORTENO MEDICAL SERVICES, S.C.
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Dates
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Enumeration Date | 03/01/2013
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Last Update Date | 03/01/2013
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Provider Practice Location Address
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Address Line | 6142 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4628
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Country | US
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Telephone | 773-767-4359
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Fax | 847-562-0202
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Provider Business Mailing Address
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Address Line | 6142 S PULASKI RD
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City | CHICAGO
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State | IL
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Zip | 60629-4628
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Country | US
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Telephone | 773-767-4359
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Fax | 847-562-0202
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GREGORY ROSENSTEIN
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Credential | M.D.
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Telephone | 773-580-5093
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 36-083647
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License Number State | IL
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