Provider Demographics
NPI:1033102926
Name:ROSALES, RICHARD NONO (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:NONO
Last Name:ROSALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 SOUTHWYCK BLVD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1509
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:1701 S CREASY LN
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:800-654-7410
Practice Address - Fax:219-502-4855
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036095306207ZP0102X
IN01041711A207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01630255OtherBC/BC
IL220032543OtherRR MEDICARE
IN200040940AMedicaid
IN351173213OtherSAGAMORE
IN351173213OtherISPAT/INLAND
IN82422OtherBC/BS
IN351173213OtherHFN
IN6828750001OtherCIGNA