MEDICARE: JACOB ROTMENSCH 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	207VX0201X	Gynecologic Oncology Physician	036-068650	IL

General Provider Information

NPI Number	:	1790746600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB ROTMENSCH M.D.

Provider Business Mailing Address
First Line	:	5732 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1719
Country	:	US
Telephone Number	:	773-909-4375
Fax Number	:

Provider Business Practice Location Address
First Line	:	5732 S KENWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60637-1719
Country	:	US
Telephone Number	:	773-909-4375
Fax Number	:

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

Provider Enumeration Date	:	03/30/2006
Last Update Date	:	02/22/2023

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