Basic Information
Provider Information
NPI: 1861488785
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ROSENBERG
FirstName: STEVEN
MiddleName: J
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7147 VISTA DR STE 150
Address2:  
City: WEST DES MOINES
State: IA
PostalCode: 502669313
CountryCode: US
TelephoneNumber: 5158759925
FaxNumber: 5158759923
Practice Location
Address1: 5950 UNIVERSITY AVE
Address2: STE 341
City: WEST DES MOINES
State: IA
PostalCode: 50266
CountryCode: US
TelephoneNumber: 5158759800
FaxNumber: 5158759802
Other Information
ProviderEnumerationDate: 09/26/2005
LastUpdateDate: 08/17/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/17/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000XMD-23533IAY Allopathic & Osteopathic PhysiciansUrology 

No ID Information.


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