Rosanwo, Matilda M
Rosanwo, Matilda M is an individual health care provider with primary practice located at 360 Station Dr , Crystal Lake IL 60014. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Rosanwo, Matilda M can be contacted via phone (815) 338-6600.Contact Information
Primary practice address
360 Station Dr
Crystal Lake IL 60014
Phone: (815) 338-6600
Fax: (815) 455-8044
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | 036104686 | Illinois |
Profile Details
| NPI number | 1871570978 |
|---|---|
| LBN Legal business name | Rosanwo, Matilda M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 29th, 2005 |
| Last updated | Oct 22nd, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871570978 | NPPES |
| Illinois | Other | 036104686 | STATE LICENSE |
| Illinois | Other | P00424928 | STATE LICENSE |
| Illinois | MEDICAID | 0361046863 | STATE LICENSE |
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