Provider Demographics
NPI:1447610761
Name:ROSE, DREW MICHAEL
Entity Type:Individual
Prefix:
First Name:DREW
Middle Name:MICHAEL
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S. SANTA FE
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4144
Mailing Address - Country:US
Mailing Address - Phone:785-452-7742
Mailing Address - Fax:785-452-7256
Practice Address - Street 1:400 S. SANTA FE
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4144
Practice Address - Country:US
Practice Address - Phone:785-452-7742
Practice Address - Fax:785-452-7256
Is Sole Proprietor?:No
Enumeration Date:2016-02-29
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-41997207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201250770AMedicaid