Provider Demographics
NPI:1023216819
Name:ROZMAN INSTITUTE OF MEDICINE REHABILITATION SC
Entity type:Organization
Organization Name:ROZMAN INSTITUTE OF MEDICINE REHABILITATION SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:MOTEL
Authorized Official - Last Name:ROZMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-608-6446
Mailing Address - Street 1:11800 CARDINAL LN
Mailing Address - Street 2:
Mailing Address - City:CALEDONIA
Mailing Address - State:IL
Mailing Address - Zip Code:61011-9774
Mailing Address - Country:US
Mailing Address - Phone:815-505-4554
Mailing Address - Fax:815-885-2175
Practice Address - Street 1:333 WAUKEGAN RD STE F
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-5122
Practice Address - Country:US
Practice Address - Phone:847-486-9643
Practice Address - Fax:847-486-9637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01635020OtherBCBS ID
IL211175Medicare ID - Type Unspecified