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Individual

JOSEPH ROSENBLUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
824 LINCOLNWAY, LOFT #2, LA PORTE, IN 46350-3411
(219) 380-5724
(219) 575-7345
Mailing address
190 E BANNOCK ST, BOISE, ID 83712-6241
(208) 706-8526
(219) 531-0859

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
02001043A
IN
207RC0000X
Cardiovascular Disease Physician
02001043A
IN
207RI0011X
Interventional Cardiology Physician
02001043A
IN
2085R0204X
Vascular & Interventional Radiology Physician
02001043A
IN
2085U0001X
Diagnostic Ultrasound Physician
02001043A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000540070
ANTHEM, BCBS
IN
01
000000792854
ANTHEM
IN
05
100356180
IN
05
100356180A
ID
Enumeration date
09/16/2005
Last updated
02/09/2016
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