Provider Demographics
NPI:1033746334
Name:ROSENTHAL, ALISON SUZANNE (MD)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:SUZANNE
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-5618
Mailing Address - Country:US
Mailing Address - Phone:630-653-4240
Mailing Address - Fax:630-933-4581
Practice Address - Street 1:285 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-5618
Practice Address - Country:US
Practice Address - Phone:630-653-4240
Practice Address - Fax:630-933-4581
Is Sole Proprietor?:No
Enumeration Date:2020-03-25
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036172117207V00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program