Provider Demographics
NPI:1588129928
Name:ROSETT PLASTIC SURGERY, LLC
Entity type:Organization
Organization Name:ROSETT PLASTIC SURGERY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:312-535-2200
Mailing Address - Street 1:777 N GREEN ST # 4
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5470
Mailing Address - Country:US
Mailing Address - Phone:312-535-2200
Mailing Address - Fax:312-766-0966
Practice Address - Street 1:1149 CROFTON AVE N
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3953
Practice Address - Country:US
Practice Address - Phone:312-535-2200
Practice Address - Fax:312-766-0966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-08
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty