Provider Demographics
NPI:1942251921
Name:ROSING, KEITH JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:JOSEPH
Last Name:ROSING
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 1:25 SHADE TREE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92603-0130
Mailing Address - Country:US
Mailing Address - Phone:949-759-8161
Mailing Address - Fax:949-854-1019
Practice Address - Street 1:25 SHADE TREE
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92603-0130
Practice Address - Country:US
Practice Address - Phone:949-759-8161
Practice Address - Fax:949-854-1019
Is Sole Proprietor?:No
Enumeration Date:2006-05-13
Last Update Date:2008-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29490207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG29490BMedicare ID - Type Unspecified
CAE81950Medicare UPIN