Provider Demographics
NPI:1972688968
Name:ROSEN, WILLIAM CLAYTON (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CLAYTON
Last Name:ROSEN
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:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-6777
Mailing Address - Fax:
Practice Address - Street 1:PWB FOURTH FLOOR, ROOM 4-100
Practice Address - Street 2:516 DELAWARE STREET SE
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-626-6777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19366208000000X, 2080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatrics
Not Answered2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0896059OtherPREFERRED ONE
MN14R30ROOtherBLUE CROSS BLUE SHIELD
MN47-78498OtherMEDICA PRIMARY
MN773187OtherARAZ
MN47-11041OtherMEDICA CHOICE
MT0055216Medicaid
MN121842OtherUCARE
MNHP11332OtherHEALTH PARTNERS
MN47-11041OtherMEDICA CHOICE