Basic Information
| Provider Information | |||||||||
| NPI: | 1831274687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROSIN | ||||||||
| FirstName: | JONATHAN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6233 CERMAK RD | ||||||||
| Address2: | |||||||||
| City: | BERWYN | ||||||||
| State: | IL | ||||||||
| PostalCode: | 604022317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7087492020 | ||||||||
| FaxNumber: | 7087492069 | ||||||||
| Practice Location | |||||||||
| Address1: | 1917 CHERRY LN. | ||||||||
| Address2: | |||||||||
| City: | NORTHBROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60062 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475642020 | ||||||||
| FaxNumber: | 8475642064 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 036-090878 | IL | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 036090878 | 05 | IL | MEDICAID | 0001622078 | 01 | IL | BLUE CROSS BLUE SHEILD | OTHER |