MEDICARE: RON ROSENBERG 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	207QS0010X	Sports Medicine (Family Medicine) Physician	ME158210	FL

General Provider Information

NPI Number	:	1598253825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RON ROSENBERG MD

Provider Business Mailing Address
First Line	:	55 W GOETHE ST UNIT 1228
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-2233
Country	:	US
Telephone Number	:	312-330-1390
Fax Number	:

Provider Business Practice Location Address
First Line	:	5821 S WILLIAMSON BLVD
Second Line	:	SUITE 203
City	:	PORT ORANGE
State	:	FL
Zip	:	32128
Country	:	US
Telephone Number	:	386-231-2960
Fax Number	:	386-231-2961

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

Provider Enumeration Date	:	04/23/2018
Last Update Date	:	03/11/2026

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Directions to “ RON ROSENBERG MD” Practice Location

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