NPIMap

Organization Active NPI

Lifeforce Medical Institute

  • Public Health & General Preventive Medicine Physician
  • Northbrook, IL
National Provider Identifier
1588078844
Registry record updated Jun 16, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health & General Preventive Medicine PhysicianTaxonomy code 2083P0901X
License
336047254 Issued in IL
Legal business name
LIFEFORCE MEDICAL INSTITUTE
Practice address
60 Revere Dr
Site 820
Northbrook, IL 60062-1563
Phone
(847) 563-4493
NPI assigned
Jun 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Rosenbloom, MD
Title
Owner
Phone
(847) 563-4493

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health & General Preventive Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2083P0901X 336047254 IL Primary

Addresses

Primary practice location

60 Revere Dr
Site 820
Northbrook, IL 60062-1563

Mailing address

60 Revere Dr
Site 820
Northbrook, IL 60062-1563
Phone (847) 563-4493

National Provider Directory

National Provider Directory
Tax ID family
Chicago Age Management Institute2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1402876800000",
    "number": "1588078844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 REVERE DR",
            "address_2": "SITE 820",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621563",
            "telephone_number": "847-563-4493"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "60 REVERE DR",
            "address_2": "SITE 820",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600621563",
            "telephone_number": "847-563-4493"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFEFORCE MEDICAL INSTITUTE",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-16",
        "last_updated": "2014-06-16",
        "status": "A",
        "authorized_official_last_name": "ROSENBLOOM",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "847-563-4493",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2083P0901X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Preventive Medicine, Public Health & General Preventive Medicine",
            "state": "IL",
            "license": "336047254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Northbrook, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.