Provider Demographics
NPI:1114931029
Name:ROSENSCHEIN, GUY RAOUL (MD)
Entity Type:Individual
Prefix:DR
First Name:GUY
Middle Name:RAOUL
Last Name:ROSENSCHEIN
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:PO BOX 6220
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72766-6220
Mailing Address - Country:US
Mailing Address - Phone:479-927-3100
Mailing Address - Fax:479-927-3131
Practice Address - Street 1:5230 WILLOW CREEK DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-0876
Practice Address - Country:US
Practice Address - Phone:479-927-3100
Practice Address - Fax:479-927-3131
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE32462086S0120X
MO20001508732086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200387580BMedicaid
AR18920000000OtherQUALCHOICE
AR5L780OtherBLUE CROSS/BLUE SHIELD
AR2718271OtherCIGNA
MO204878001Medicaid
OK100224750AMedicaid
AR140114001Medicaid
AR45052125072764A003OtherCHAMPUS/TRICARE
AR515046OtherHEALTHLINK
OK100224750AMedicaid
MO204878001Medicaid
AR515046OtherHEALTHLINK