Healthcare Provider Details

I. General information

NPI: 1467534297
Provider Name (Legal Business Name): GARY JOHN ROSENMEIER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1061 E COMMERCE BLVD
SLINGER WI
53086-9326
US

IV. Provider business mailing address

1061 E COMMERCE BLVD
SLINGER WI
53086-9326
US

V. Phone/Fax

Practice location:
  • Phone: 262-644-2900
  • Fax:
Mailing address:
  • Phone: 262-644-2900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37584
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: