Provider Demographics
NPI:1508881160
Name:ROSENBERG, PAUL S (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:S
Last Name:ROSENBERG
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 3395
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47732-3395
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1373 E SR 62
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250
Practice Address - Country:US
Practice Address - Phone:812-801-0848
Practice Address - Fax:812-801-0774
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035954207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
4370893OtherAETNA
IN100149010AMedicaid
KY2435128000OtherPASSPORT ADVANTAGE
KY1073893OtherPASSPORT KY MEDICAID
IN410014POtherSIHO
KY64759699Medicaid
IN000000042209OtherANTHEM BCBS
200034109OtherMEDICARE RAILROAD
IN412840OMedicare ID - Type Unspecified
KY0875803Medicare ID - Type Unspecified
IN100149010AMedicaid
IN000000042209OtherANTHEM BCBS
200034109OtherMEDICARE RAILROAD