Provider Demographics
NPI:1407831076
Name:ROSEN, ADAM MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:ROSEN
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 1:612 DRUID RD E
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3912
Mailing Address - Country:US
Mailing Address - Phone:727-443-6400
Mailing Address - Fax:727-443-5590
Practice Address - Street 1:612 DRUID RD E
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3912
Practice Address - Country:US
Practice Address - Phone:727-443-6400
Practice Address - Fax:727-443-5590
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66431207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25407ZMedicare PIN
FLF82298Medicare UPIN
FL660001103Medicare PIN