Provider Demographics
NPI:1568461416
Name:ROSENBAUM, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROSENBAUM
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 1:3630 GUION RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46222-1616
Mailing Address - Country:US
Mailing Address - Phone:317-920-7195
Mailing Address - Fax:317-920-7551
Practice Address - Street 1:3630 GUION RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46222-1616
Practice Address - Country:US
Practice Address - Phone:317-920-7195
Practice Address - Fax:317-920-7551
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033600207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01033600OtherSTATE LICENSE NO.
IN000000191627OtherANTHEM PROVIDER NUMBER
IN01033600OtherSTATE LICENSE NO.
INC24379Medicare UPIN