Provider Demographics
NPI:1104862523
Name:ROSARIO, INELL COESETA (MD)
Entity Type:Individual
Prefix:MRS
First Name:INELL
Middle Name:COESETA
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 BLAINE AVE
Mailing Address - Street 2:SUITE 225
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-1238
Mailing Address - Country:US
Mailing Address - Phone:651-888-7803
Mailing Address - Fax:651-888-7820
Practice Address - Street 1:5565 BLAINE AVE
Practice Address - Street 2:SUITE 225
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1238
Practice Address - Country:US
Practice Address - Phone:651-888-7800
Practice Address - Fax:651-888-7801
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN39684207Y00000X, 208600000X, 207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN824517700Medicaid
MN1104862523Medicaid
MN1104862523Medicaid
MN824517700Medicaid