Provider Demographics
NPI:1528020039
Name:ROSENTHAL, PAUL M (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1745 DOUSMAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-3245
Mailing Address - Country:US
Mailing Address - Phone:920-494-9661
Mailing Address - Fax:920-491-5620
Practice Address - Street 1:403 BURKARTH ROAD
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093
Practice Address - Country:US
Practice Address - Phone:660-747-2500
Practice Address - Fax:660-747-8455
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-06-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI34369207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34198300Medicaid
WIF55859Medicare UPIN
WI34198300Medicaid