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General NPI Number Information
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NPI Number | 1366838369
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Entity Type | Organization
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Legal Business Name | ROSE INTERNAL MEDICINE
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Dates
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Enumeration Date | 04/07/2015
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Last Update Date | 04/07/2015
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Provider Practice Location Address
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Address Line | 4545 E 9TH AVE SUITE 370
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City | DENVER
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State | CO
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Zip | 80220-3901
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Country | US
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Telephone | 303-320-7340
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Fax | 303-320-7341
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Provider Business Mailing Address
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Address Line | 4545 E 9TH AVE SUITE 370
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City | DENVER
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State | CO
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Zip | 80220-3901
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Country | US
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Telephone | 303-320-7340
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Fax | 303-320-7341
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. WILLIAM KUBASKA
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Credential | M.D.
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Telephone | 303-320-7340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0004148
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License Number State | CO
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