Provider Demographics
NPI:1871615419
Name:ROSSELSON, MARIA E (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:E
Last Name:ROSSELSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:806 CENTRAL AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-5613
Mailing Address - Country:US
Mailing Address - Phone:847-432-6010
Mailing Address - Fax:847-432-8241
Practice Address - Street 1:806 CENTRAL AVE
Practice Address - Street 2:STE 300
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-5613
Practice Address - Country:US
Practice Address - Phone:847-432-6010
Practice Address - Fax:847-432-8241
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036117933207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL03617933Medicaid
ILP00408814OtherRAILROAD MEDICARE
ILK38758Medicare PIN
ILP00408814OtherRAILROAD MEDICARE
ILK38747Medicare PIN