Provider Demographics
NPI:1972530442
Name:ROSARIO, ELMO J (MD)
Entity type:Individual
Prefix:
First Name:ELMO
Middle Name:J
Last Name:ROSARIO
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Gender:M
Credentials:MD
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Mailing Address - Street 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:605-719-7109
Mailing Address - Fax:605-719-1027
Practice Address - Street 1:2805 5TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701
Practice Address - Country:US
Practice Address - Phone:605-719-5700
Practice Address - Fax:605-719-5701
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-08-04
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Provider Licenses
StateLicense IDTaxonomies
SD2375207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDP00368653OtherRR MEDICARE
SD6000633Medicaid
SD2375OtherDAKOTACARE
SD4993467OtherWELLMARK
SD4993467OtherWELLMARK
SDP00368653OtherRR MEDICARE
SD2375OtherDAKOTACARE