Provider Demographics
NPI:1598752826
Name:ROSENQUIST, RICHARD W (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:ROSENQUIST
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:PAIN MANAGEMENT C25
Mailing Address - Street 2:9500 EUCLID AVENUE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-445-8388
Mailing Address - Fax:216-445-7928
Practice Address - Street 1:PAIN MANAGEMENT C25
Practice Address - Street 2:9500 EUCLID AVENUE
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-445-8388
Practice Address - Fax:216-445-7928
Is Sole Proprietor?:No
Enumeration Date:2005-10-03
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA32213207L00000X, 207LP2900X
OH096179207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3154670Medicaid
IA0169037Medicaid
IA42321OtherWELLMARK BCBS
IA42321OtherWELLMARK BCBS
IA050061451Medicare PIN
IA0169037Medicaid