Individual
BRUCE M. ROSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
8075 N SHADELAND AVE, SUITE 200, INDIANAPOLIS, IN 46250-2693
(317) 621-8500
(317) 621-8501
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2805
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
71000638A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200184600
—
IN
01
—
P01214655
RR MEDICARE PTAN
IN
Enumeration date
05/03/2006
Last updated
06/14/2021
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