Provider Demographics
NPI:1831164714
Name:ROSADO, IVAN R (MD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:R
Last Name:ROSADO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:661 E ATTAMONTE DR
Mailing Address - Street 2:STE 331
Mailing Address - City:ATTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701
Mailing Address - Country:US
Mailing Address - Phone:407-830-8787
Mailing Address - Fax:407-830-1677
Practice Address - Street 1:661 E ATTAMONTE DR
Practice Address - Street 2:STE 331
Practice Address - City:ATTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701
Practice Address - Country:US
Practice Address - Phone:407-830-8787
Practice Address - Fax:407-830-1677
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME0047059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL656248OtherAETNA
D00202Medicare UPIN
FL656248OtherAETNA