Provider Demographics
NPI:1235245853
Name:ROSENBERG, THOMAS F (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:ROSENBERG
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 1:17 NORFOLK DR
Mailing Address - Street 2:
Mailing Address - City:EASTBOROUGH
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4426
Mailing Address - Country:US
Mailing Address - Phone:316-686-0666
Mailing Address - Fax:
Practice Address - Street 1:8535 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-2911
Practice Address - Country:US
Practice Address - Phone:316-609-2385
Practice Address - Fax:316-609-2346
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0414905207K00000X
KS14905302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR6052423OtherDEA
AR6052423OtherDEA
1081Medicare ID - Type Unspecified