Individual
SHANE J ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11900 N PENNSYLVANIA STREET, CARMEL, IN 46032-4694
(317) 846-0717
(317) 846-0557
Mailing address
PO BOX 2303, DEPT 163, INDIANAPOLIS, IN 46206
(952) 542-8553
(952) 513-6880
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
01049705A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200250980
—
IN
Enumeration date
03/02/2006
Last updated
02/16/2012
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