Provider Demographics
NPI:1568494169
Name:ROSENBERG, LINDA E (DO)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:E
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9250 COLUMBIA AVE
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-3538
Mailing Address - Country:US
Mailing Address - Phone:219-931-5110
Mailing Address - Fax:219-931-0307
Practice Address - Street 1:9250 COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3538
Practice Address - Country:US
Practice Address - Phone:219-931-5110
Practice Address - Fax:219-931-0307
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000824207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100214460Medicaid
IN707550Medicare ID - Type UnspecifiedPROVIDER NUMBER
IN100214460Medicaid