Organization Name: | MARVIN J ROSSER MD LTD |
NPI Number: | 1508972498 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | MARVIN J ROSSER (PRESIDENT) |
Mailing Address: | 117 S Cook St #114 Barrington |
State: | IL US |
Postal Code: | 600104311 |
Phone Number: | 8472266017 |
Fax Number: | |
NPI Enumeration Date: | 08/22/2006 |
NPI Last Update Date: | 07/21/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 042.006016 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |