MEDICARE: CLEMENT S ROSE M.D.

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	207R00000X	Internal Medicine Physician	036069325	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346238177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEMENT S ROSE M.D.

Provider Business Mailing Address
First Line	:	4646 N MARINE DR STE A6100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5759
Country	:	US
Telephone Number	:	773-564-5444
Fax Number	:	773-564-5445

Provider Business Practice Location Address
First Line	:	4646 N MARINE DR STE A6100
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-5759
Country	:	US
Telephone Number	:	773-564-5444
Fax Number	:	773-564-5445

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	10/26/2020

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Directions to “ CLEMENT S ROSE M.D.” Practice Location

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