Provider Demographics
NPI:1760443915
Name:ROSENQUIST, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
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 1:619 AVENIDA DE MAYO
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34242-1501
Mailing Address - Country:US
Mailing Address - Phone:620-262-7202
Mailing Address - Fax:620-262-7202
Practice Address - Street 1:265 BATH CLUB BLVD S
Practice Address - Street 2:
Practice Address - City:NORTH REDINGTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1531
Practice Address - Country:US
Practice Address - Phone:620-262-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-277572085U0001X, 2085R0202X, 2085B0100X
FLME1085662085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205477409Medicaid
OK200047060AMedicaid
KS104327OtherBCBS
KS100400450BMedicaid
KS100400450BMedicaid
P00177660Medicare PIN
MO205477409Medicaid
OK200047060AMedicaid