Healthcare Provider Details

I. General information

NPI: 1124058755
Provider Name (Legal Business Name): ROBERT L ROSIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MAIN ST
ULYSSES KS
67880-2135
US

IV. Provider business mailing address

505 N MAIN ST
ULYSSES KS
67880-2135
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-1261
  • Fax: 620-356-3846
Mailing address:
  • Phone: 620-356-1261
  • Fax: 620-356-3846

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0421475
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL3827
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberM-10257
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0421475
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: