Individual
SUSAN P ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6820 PARKDALE PL, SUITE 100, INDIANAPOLIS, IN 46254-6601
(317) 297-7773
(317) 297-3619
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
01037465A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100131110
—
IN
Enumeration date
05/10/2006
Last updated
02/27/2014
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