Individual
ROSENBERG ACOSTA REYES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
320 WEST WOODLAWN AVE, LOUISVILLE, KY 40214
(502) 368-2563
(502) 368-2427
Mailing address
320 WEST WOODLAWN AVE, LOUISVILLE, KY 40214
(502) 368-2563
(502) 368-2427
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35249
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000209925
ANTHEM PROVIDER ID
KY
01
—
000000209925
BCBS ANTHEM ID
—
01
—
080178783
RR MEDICARE PROV. ID
KY
01
—
1158227
PASSPORT PROV. ID
KY
01
—
595419196
MEDICARE PTAN
KY
05
—
64004104
—
KY
Enumeration date
02/08/2006
Last updated
11/30/2016
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