MEDICARE: MARY K ROSENOW MD, PHD

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	208600000X	Surgery Physician	IL036060221	IL

General Provider Information

NPI Number	:	1023080702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY K ROSENOW MD, PHD

Provider Business Mailing Address
First Line	:	1135 POSSUM RD
Second Line	:
City	:	TUNNEL HILL
State	:	IL
Zip	:	62972-3138
Country	:	US
Telephone Number	:	270-994-6969
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 POSSUM RD
Second Line	:
City	:	TUNNEL HILL
State	:	IL
Zip	:	62972-3138
Country	:	US
Telephone Number	:	270-994-6969
Fax Number	:

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	03/24/2015

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