MEDICARE: DR. WILLIAM A ROSENBERG M.D.

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	207QS0010X	Sports Medicine (Family Medicine) Physician	14987	NV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538106497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM A ROSENBERG M.D.

Provider Business Mailing Address
First Line	:	2913 SAINT ROMAN ST STE 100
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89044-0364
Country	:	US
Telephone Number	:	702-803-0552
Fax Number	:

Provider Business Practice Location Address
First Line	:	801 S RANCHO DR STE F2
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-3814
Country	:	US
Telephone Number	:	702-877-6781
Fax Number	:

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	01/04/2022

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