Provider Demographics
NPI:1639259005
Name:ROSENBERG, DAVID MORTON (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MORTON
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 N MILWAUKEE ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-6012
Mailing Address - Country:US
Mailing Address - Phone:414-227-1127
Mailing Address - Fax:
Practice Address - Street 1:163 N MILWAUKEE ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-6012
Practice Address - Country:US
Practice Address - Phone:414-227-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19608-21208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68015-0130Medicare PIN
WI02120-0011Medicare PIN