MEDICARE: ROSE NGISHU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	R6059	TX

General Provider Information

NPI Number	:	1063809531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE NGISHU MD

Provider Business Mailing Address
First Line	:	1001 N WALDROP DR STE 602
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76012-4714
Country	:	US
Telephone Number	:	817-277-4723
Fax Number	:	817-274-5143

Provider Business Practice Location Address
First Line	:	1004 WINSCOTT RD
Second Line	:
City	:	BENBROOK
State	:	TX
Zip	:	76126-2776
Country	:	US
Telephone Number	:	817-249-0111
Fax Number	:	817-249-0110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	11/05/2025

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Directions to “ ROSE NGISHU MD” Practice Location

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