Provider Demographics
NPI:1366652547
Name:ROSEN, THOMAS M (PA-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:ROSEN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9650 GROSS POINT RD STE 2900
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-5006
Mailing Address - Country:US
Mailing Address - Phone:478-667-8468
Mailing Address - Fax:224-251-5074
Practice Address - Street 1:9650 GROSS POINT RD STE 29
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-5080
Practice Address - Country:US
Practice Address - Phone:847-866-7846
Practice Address - Fax:224-251-5074
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2024-07-19
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Provider Licenses
StateLicense IDTaxonomies
IL085-002318363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical