Provider Demographics
NPI:1790992238
Name:ROSE INTERNAL MEDICINE & DIABETES
Entity Type:Organization
Organization Name:ROSE INTERNAL MEDICINE & DIABETES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KUBASKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-320-7340
Mailing Address - Street 1:4545 E 9TH AVE
Mailing Address - Street 2:SUITE 370
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3901
Mailing Address - Country:US
Mailing Address - Phone:303-320-7340
Mailing Address - Fax:303-320-7341
Practice Address - Street 1:4545 E 9TH AVE
Practice Address - Street 2:SUITE 370
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3901
Practice Address - Country:US
Practice Address - Phone:303-320-7340
Practice Address - Fax:303-320-7341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C636608Medicare UPIN