MEDICARE: ABIGAIL CLAIRE ROUSSEAU

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	125.088043	IL

General Provider Information

NPI Number	:	1023940608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL CLAIRE ROUSSEAU

Provider Business Mailing Address
First Line	:	1750 W HARRISON ST STE 775
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 W HARRISON ST STE 775
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3825
Country	:	US
Telephone Number	:	312-942-1627
Fax Number	:

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

Provider Enumeration Date	:	05/30/2026
Last Update Date	:	06/10/2026

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Directions to “ ABIGAIL CLAIRE ROUSSEAU ” Practice Location

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