MEDICARE: RICHARD NONO ROSALES MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	036095306	IL
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01041711A	IN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	220032543	OTHER	IL	RR MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01630255	OTHER	IL	BC/BC
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	351173213	OTHER	IN	SAGAMORE
5	351173213	OTHER	IN	ISPAT/INLAND
6	82422	OTHER	IN	BC/BS
7	351173213	OTHER	IN	HFN
8	6828750001	OTHER	IN	CIGNA

NPI Number	:	1033102926
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD NONO ROSALES MD

Provider Business Mailing Address
First Line	:	5700 SOUTHWYCK BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43614-1509
Country	:	US
Telephone Number	:	800-288-8325
Fax Number	:	419-866-5453

Provider Business Practice Location Address
First Line	:	1701 S CREASY LN
Second Line	:
City	:	LAFAYETTE
State	:	IN
Zip	:	47905-4972
Country	:	US
Telephone Number	:	800-654-7410
Fax Number	:	219-502-4855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	01/23/2024

1701 S CREASY LN RM 1K71
LAFAYETTE, IN
47905-4972

Practice Phone: 765-502-4499
Practice Fax: