Provider Demographics
NPI:1548255474
Name:ROSANOVA-KAPER, MARY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:ROSANOVA-KAPER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:330 E MAIN ST
Mailing Address - Street 2:STE 1-W
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-3203
Mailing Address - Country:US
Mailing Address - Phone:847-381-4300
Mailing Address - Fax:847-381-4350
Practice Address - Street 1:330 E MAIN ST
Practice Address - Street 2:STE 1-W
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-3203
Practice Address - Country:US
Practice Address - Phone:847-381-4300
Practice Address - Fax:847-381-4350
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2010-08-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036042248207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042248Medicaid
D89159Medicare UPIN
IL036042248Medicaid