Provider Demographics
NPI:1487626768
Name:ROSENBERG, WILLIAM S (M D)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 N RIVERSIDE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64507-2508
Mailing Address - Country:US
Mailing Address - Phone:816-271-4025
Mailing Address - Fax:816-271-4026
Practice Address - Street 1:802 N RIVERSIDE RD STE 150
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64507-2508
Practice Address - Country:US
Practice Address - Phone:816-271-4025
Practice Address - Fax:816-271-4026
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2025-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002010265174400000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100450120AMedicaid
MO205854409Medicaid
KS100450120AMedicaid
F71513Medicare UPIN