1023216819 NPI number — ROZMAN INSTITUTE OF MEDICINE REHABILITATION SC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023216819 NPI number — ROZMAN INSTITUTE OF MEDICINE REHABILITATION SC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROZMAN INSTITUTE OF MEDICINE REHABILITATION SC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023216819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11800 CARDINAL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CALEDONIA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61011-9774
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-505-4554
Provider Business Mailing Address Fax Number:
815-885-2175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 WAUKEGAN RD STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENVIEW
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60025-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-486-9643
Provider Business Practice Location Address Fax Number:
847-486-9637
Provider Enumeration Date:
07/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROZMAN
Authorized Official First Name:
ANATOLY
Authorized Official Middle Name:
MOTEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
815-608-6446

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01635020 . This is a "BCBS ID" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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