Provider Demographics
NPI:1881764868
Name:BOSCH, ROSANNE LINDA (MD)
Entity type:Individual
Prefix:DR
First Name:ROSANNE
Middle Name:LINDA
Last Name:BOSCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROSANNE
Other - Middle Name:LINDA
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1205 S GRANGE AVE
Practice Address - Street 2:STE 307
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0407
Practice Address - Country:US
Practice Address - Phone:605-328-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE23627174400000X
SD8546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE23627OtherSTATE MEDICAL LICENSE