Provider Demographics
NPI:1477630465
Name:ROSICH, WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:ROSICH
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 1570
Mailing Address - Street 2:VALLE ARRIBA HTS STA
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-1570
Mailing Address - Country:US
Mailing Address - Phone:787-717-0099
Mailing Address - Fax:787-272-6612
Practice Address - Street 1:C8 S817
Practice Address - Street 2:VILLAS DE PARANA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-6131
Practice Address - Country:US
Practice Address - Phone:787-272-6612
Practice Address - Fax:787-272-6612
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5435208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
3354OtherAM HEALTH CARE
065306OtherCRUZ AZUL
26373OtherTRIPLE S
0026373Medicare ID - Type Unspecified
C77412Medicare UPIN