Provider Demographics
NPI:1760040315
Name:KARL G. ROSE M.D., INC.
Entity Type:Organization
Organization Name:KARL G. ROSE M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-294-2555
Mailing Address - Street 1:PO BOX 292305
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-0305
Mailing Address - Country:US
Mailing Address - Phone:937-294-2555
Mailing Address - Fax:937-294-3211
Practice Address - Street 1:3017 WILMINGTON PIKE
Practice Address - Street 2:
Practice Address - City:KETTERING
Practice Address - State:OH
Practice Address - Zip Code:45429-4075
Practice Address - Country:US
Practice Address - Phone:937-294-2555
Practice Address - Fax:937-294-3211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-30
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty