| Mario C. Rosas, M.d., S.c. | |
|
2619 S Lawndale Ave Front Chicago IL 60623-4520 | |
| (773) 522-2620 | |
| (773) 522-2641 |
| Full Name | Mario C. Rosas, M.d., S.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 2619 S Lawndale Ave, Chicago, Illinois |
| Authorized Official Name and Position | Mario C Rosas (PRESIDENT) |
| Authorized Official Contact | 7735222620 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mario C. Rosas, M.d., S.c. 2619 S Lawndale Ave Front Chicago IL 60623-4520 Ph: (773) 522-2620 | Mario C. Rosas, M.d., S.c. 2619 S Lawndale Ave Front Chicago IL 60623-4520 Ph: (773) 522-2620 |
| NPI Number | 1194901280 |
|---|---|
| Provider Enumeration Date | 01/18/2008 |
| Last Update Date | 06/14/2016 |
| Medicare PECOS PAC ID | 7911081146 |
|---|---|
| Medicare Enrollment ID | O20080227000376 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194901280 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036074065 (Illinois) | Primary |
| Provider Name | Mario C Rosas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1841369881 PECOS PAC ID: 7012091242 Enrollment ID: I20080630000643 |
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