Provider Demographics
NPI:1811981970
Name:ROSENCRANZ, MARYLYN A (DO)
Entity type:Individual
Prefix:DR
First Name:MARYLYN
Middle Name:A
Last Name:ROSENCRANZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5363 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-5325
Mailing Address - Country:US
Mailing Address - Phone:219-769-5000
Mailing Address - Fax:574-273-1137
Practice Address - Street 1:5363 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5325
Practice Address - Country:US
Practice Address - Phone:219-769-5000
Practice Address - Fax:574-273-1137
Is Sole Proprietor?:No
Enumeration Date:2005-09-06
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN020010082085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200288940Medicaid
INP00719157OtherRAIL ROAD CARE
IN000000576548OtherANTHEM
IL036064791Medicaid
IN200288940Medicaid
IN197130GMedicare PIN