Provider Demographics
NPI:1306237417
Name:ROSENBERG, AARON (MD)
Entity type:Individual
Prefix:DR
First Name:AARON
Middle Name:
Last Name:ROSENBERG
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:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:THIENSVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53092-0639
Mailing Address - Country:US
Mailing Address - Phone:262-242-0700
Mailing Address - Fax:855-457-1293
Practice Address - Street 1:1516 W MEQUON RD STE 103
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3264
Practice Address - Country:US
Practice Address - Phone:262-242-0700
Practice Address - Fax:855-457-1293
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI63589-20208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI63589OtherSTATE LICENSE
WI100052457Medicaid