Provider Demographics
NPI:1174732770
Name:ROSE, THERESA LINDSAY (DO)
Entity type:Individual
Prefix:DR
First Name:THERESA
Middle Name:LINDSAY
Last Name:ROSE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:THERESA
Other - Middle Name:LINDSAY
Other - Last Name:ZAITA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 N WESTMORELAND RD STE 112
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60045-1688
Mailing Address - Country:US
Mailing Address - Phone:847-535-7057
Mailing Address - Fax:847-615-2260
Practice Address - Street 1:900 N WESTMORELAND RD STE 112
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:IL
Practice Address - Zip Code:60045-1688
Practice Address - Country:US
Practice Address - Phone:847-535-7057
Practice Address - Fax:847-615-2260
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125066048207V00000X
FLARNP9243415363LW0102X
IL036145074207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health