Provider Demographics
NPI:1487690079
Name:ROSEN, REUVEN E (MD)
Entity Type:Individual
Prefix:
First Name:REUVEN
Middle Name:E
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 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 480
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-388-9321
Mailing Address - Fax:303-388-3910
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 480
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-388-9321
Practice Address - Fax:303-388-3910
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15880174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01158807Medicaid
COD22941Medicare UPIN
COC72424Medicare ID - Type Unspecified