MEDICARE: ROSETT PLASTIC SURGERY, LLC

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	2086S0122X	Plastic and Reconstructive Surgery Physician

General Provider Information

NPI Number	:	1497647614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSETT PLASTIC SURGERY, LLC

Provider Business Mailing Address
First Line	:	2461 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1942
Country	:	US
Telephone Number	:	312-535-2200
Fax Number	:	312-766-0966

Provider Business Practice Location Address
First Line	:	2461 N CLYBOURN AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1942
Country	:	US
Telephone Number	:	312-535-2200
Fax Number	:	312-766-0966

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BRIAN ROSETT
Credential	:	MD
Telephone Number	:	312-535-2200

Provider Enumeration Date	:	07/21/2025
Last Update Date	:	07/21/2025

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