Healthcare Provider Details

I. General information

NPI: 1831434455
Provider Name (Legal Business Name): ERAN ROSENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2012
Last Update Date: 04/06/2023
Certification Date: 04/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3999 DUTCHMANS LN STE 6
LOUISVILLE KY
40207-4744
US

IV. Provider business mailing address

PO BOX 950202
LOUISVILLE KY
40295-0202
US

V. Phone/Fax

Practice location:
  • Phone: 502-394-1999
  • Fax: 502-394-1999
Mailing address:
  • Phone: 502-588-9490
  • Fax: 502-272-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number47612
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: