Healthcare Provider Details

I. General information

NPI: 1750743159
Provider Name (Legal Business Name): ANDREW CHARLES ROSE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2016
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N 92ND ST STE 730
MILWAUKEE WI
53226-4875
US

IV. Provider business mailing address

999 N 92ND ST STE 730
MILWAUKEE WI
53226-4875
US

V. Phone/Fax

Practice location:
  • Phone: 414-337-7030
  • Fax: 414-337-7068
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number69089-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: