Provider Demographics
NPI:1255334157
Name:ROSEN, WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:112 SAINT OLAF AVE S
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:MN
Practice Address - Zip Code:56220-1433
Practice Address - Country:US
Practice Address - Phone:507-223-7221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26970208800000X
IL036085566208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0904144Medicaid
IA0055038Medicaid
IA1346229192OtherNPI# UROLOGICAL ASSC PC
IL1346229192OtherNPI# UROLOGICAL ASSC PC
IA340005330OtherMEDICARE RAILROAD
IL340019106OtherMEDICARE RAILROAD
IL340019106OtherMEDICARE RAILROAD
ILC30654Medicare UPIN
IAC30654Medicare UPIN
IA0055038Medicaid
IA07364Medicare PIN
IA27112Medicare ID - Type Unspecified
IA0904144Medicaid
IA0184500001Medicare NSC