Provider Demographics
NPI:1124058755
Name:ROSIN, ROBERT L (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:ROSIN
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 1:505 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ULYSSES
Mailing Address - State:KS
Mailing Address - Zip Code:67880-2135
Mailing Address - Country:US
Mailing Address - Phone:620-356-1261
Mailing Address - Fax:620-356-3846
Practice Address - Street 1:505 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ULYSSES
Practice Address - State:KS
Practice Address - Zip Code:67880-2135
Practice Address - Country:US
Practice Address - Phone:620-356-1261
Practice Address - Fax:620-356-3846
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0421475207R00000X, 208M00000X
IDTL3827207R00000X
IDM-10257207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010167120OtherRBS ID
ID77277OtherBLUE CROSS
ID807999800Medicaid
KS100208140DMedicaid
ID344118OtherALTIUS
ID344118OtherALTIUS
D05381Medicare UPIN
KS106737Medicare PIN