Provider Demographics
NPI:1043366594
Name:ROSENBERG, LARRY ALLEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:ALLEN
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7301 E 90TH ST
Mailing Address - Street 2:SUITE 112
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-7206
Mailing Address - Country:US
Mailing Address - Phone:317-773-7787
Mailing Address - Fax:317-773-2226
Practice Address - Street 1:2024 LINDBERG RD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-2716
Practice Address - Country:US
Practice Address - Phone:765-643-2987
Practice Address - Fax:765-640-0079
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000459A213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
508770010OtherMEDICARE
IN100172400AMedicaid
INT34894Medicare UPIN