MEDICARE: ROSE UROLOGY, LLC

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	208800000X	Urology Physician

General Provider Information

NPI Number	:	1861123697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSE UROLOGY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 644373
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32964-4373
Country	:	US
Telephone Number	:	772-564-1799
Fax Number	:

Provider Business Practice Location Address
First Line	:	49 ROYAL PALM PT STE 100
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4270
Country	:	US
Telephone Number	:	772-564-1799
Fax Number	:	772-494-1975

Authorized Official
Title or Position	:	MD
Name	:	DR. MARC C ROSE
Credential	:	MD
Telephone Number	:	772-564-1799

Provider Enumeration Date	:	06/22/2022
Last Update Date	:	04/04/2023

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