Provider Demographics
NPI:1487626768
Name:ROSENBERG, WILLIAM S (M D)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6420 PROSPECT AVE
Mailing Address - Street 2:SUITE T411
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-4147
Mailing Address - Country:US
Mailing Address - Phone:816-363-2500
Mailing Address - Fax:816-363-8741
Practice Address - Street 1:6420 PROSPECT AVE
Practice Address - Street 2:SUITE T411
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-4147
Practice Address - Country:US
Practice Address - Phone:816-363-2500
Practice Address - Fax:816-363-8741
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-27966174400000X
MO2002010265174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100450120AMedicaid
MO205854409Medicaid
KS100450120AMedicaid
F71513Medicare UPIN