Organization
MUNDO F. ROSALES, M.D. P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KELLY R. ROSALES (OFFICE MANAGER)
(812) 277-0075
Entity
Organization
Contact information
Practice address
2512 Q ST, SUITE B, BEDFORD, IN 47421-4928
(812) 277-0075
(812) 277-0089
Mailing address
PO BOX 324, BEDFORD, IN 47421-0324
(812) 277-0075
(812) 277-0089
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
01061216A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000594475
BLUE SHIELD
IN
05
—
200528920
—
IN
05
—
200528920A
—
IN
Enumeration date
10/30/2007
Last updated
04/16/2009
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