Provider Demographics
NPI:1245255959
Name:ROSALES, RAYMUNDO FEDERICO II (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMUNDO
Middle Name:FEDERICO
Last Name:ROSALES
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MUNDO
Other - Middle Name:FEDERICO
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 324
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-0324
Mailing Address - Country:US
Mailing Address - Phone:812-277-0075
Mailing Address - Fax:812-277-0089
Practice Address - Street 1:2512 Q ST
Practice Address - Street 2:SUITE B
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-4928
Practice Address - Country:US
Practice Address - Phone:812-277-0075
Practice Address - Fax:812-277-0089
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061216A174400000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000594475OtherBLUE SHIELD
IN200528920Medicaid
IN200528920AMedicaid
F83125Medicare UPIN
IN200528920Medicaid
IN131180QQQMedicare PIN