Individual
DR. MICHAEL WARD ROSENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 E BROADWAY AVE, SUITE #229, JACKSON, WY 83001-8640
(307) 739-7690
(307) 739-7644
Mailing address
PO BOX 428, JACKSON, WY 83001-0428
(307) 739-7690
(307) 739-7644
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
147502
NY
208600000X
Surgery Physician
Primary
8000A
WY
208600000X
Surgery Physician
M-10577
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00953517
—
NY
05
—
127072900
—
WY
01
—
P01354282
PALMETTO GBA MRR
WY
01
—
W26174
NORIDIAN MEDICARE SJMC
WY
Enumeration date
02/13/2006
Last updated
01/03/2015
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