Individual
CHARLES HOWARD ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2205 W SUDBURY DR, SUITE A, BLOOMINGTON, IN 47403-3737
(812) 961-1540
(812) 961-1535
Mailing address
2205 W SUDBURY DR, SUITE A, BLOOMINGTON, IN 47403-3737
(812) 961-1540
(812) 961-1535
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01054413A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000362446
BLUE CROSS BLUE SHIELD
IN
05
—
200398080
—
IN
01
—
P00235073
RAILROAD MEDICARE
IN
Enumeration date
11/02/2005
Last updated
09/22/2011
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