Healthcare Provider Details

I. General information

NPI: 1760040315
Provider Name (Legal Business Name): KARL G. ROSE M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2019
Last Update Date: 08/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 WILMINGTON PIKE
KETTERING OH
45429-4075
US

IV. Provider business mailing address

PO BOX 292305
KETTERING OH
45429-0305
US

V. Phone/Fax

Practice location:
  • Phone: 937-294-2555
  • Fax: 937-294-3211
Mailing address:
  • Phone: 937-294-2555
  • Fax: 937-294-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARL ROSE
Title or Position: OWNER
Credential: MD
Phone: 937-294-2555