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Individual

DAVID ROSEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
24 SANDPIPER CT., WICHITA, KS 67230
(316) 204-9157
(316) 263-2413
Mailing address
24 SANDPIPER CT., WICHITA, KS 67230
(316) 204-9157
(316) 263-2413

Taxonomy

Speciality
Code
Description
License number
State
174400000X
Specialist
0416076
KS
174400000X
Specialist
Primary
16076
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
02879
BLUE CROSS BLUE SHIELD
KS
05
100086810A
KS
Enumeration date
03/09/2006
Last updated
10/23/2018
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