Provider Demographics
NPI:1003196866
Name:ROSENBERG FAMILY PRACTICE
Entity Type:Organization
Organization Name:ROSENBERG FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:219-931-5110
Mailing Address - Street 1:5500 HOHMAN AVE
Mailing Address - Street 2:2 D
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-1965
Mailing Address - Country:US
Mailing Address - Phone:219-931-5110
Mailing Address - Fax:219-931-0307
Practice Address - Street 1:5500 HOHMAN AVE
Practice Address - Street 2:2 D
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46320-1965
Practice Address - Country:US
Practice Address - Phone:219-931-5110
Practice Address - Fax:219-931-0307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-25
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000824A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty