MEDICARE: NEIL ROSENQUIST 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	2085U0001X	Diagnostic Ultrasound Physician	04-27757	KS
2	2085R0202X	Diagnostic Radiology Physician	04-27757	KS
3	2085B0100X	Body Imaging Physician	04-27757	KS
4	2085R0202X	Diagnostic Radiology Physician	ME108566	FL

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	104327	OTHER	KS	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760443915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL ROSENQUIST MD

Provider Business Mailing Address
First Line	:	619 AVENIDA DE MAYO
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34242-1501
Country	:	US
Telephone Number	:	620-262-7202
Fax Number	:	620-262-7202

Provider Business Practice Location Address
First Line	:	265 BATH CLUB BLVD S
Second Line	:
City	:	NORTH REDINGTON BEACH
State	:	FL
Zip	:	33708-1531
Country	:	US
Telephone Number	:	620-262-7202
Fax Number	:

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	01/11/2024

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Directions to “ NEIL ROSENQUIST MD” Practice Location

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