MEDICARE: DR. MICHAEL PERRY ROSENBAUM MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	036-068332	IL

General Provider Information

NPI Number	:	1003891987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL PERRY ROSENBAUM MD

Provider Business Mailing Address
First Line	:	9977 WOODS DR
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1057
Country	:	US
Telephone Number	:	847-663-8163
Fax Number	:	847-663-1024

Provider Business Practice Location Address
First Line	:	9977 WOODS DR
Second Line	:
City	:	SKOKIE
State	:	IL
Zip	:	60077-1057
Country	:	US
Telephone Number	:	847-663-8163
Fax Number	:	847-663-1024

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/06/2020

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