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NPI Code Detail

MEDICARE: CLEMENT S ROSE M.D.

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
1207R00000XInternal Medicine Physician036069325IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID 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 : 5025 N PAULINA ST STE 501
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2772
Country : US
Telephone Number : 773-599-4363
Fax Number : 773-599-4788
Provider Business Practice Location Address
First Line : 5025 N PAULINA ST STE 501
Second Line :
City : CHICAGO
State : IL
Zip : 60640-2772
Country : US
Telephone Number : 773-599-4363
Fax Number : 773-599-4788
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2005
Last Update Date : 12/24/2025

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