Basic Information
| Provider Information | |||||||||
| NPI: | 1346408952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSENOW | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | RONALD NEWTON | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 411 LAUREL ST | ||||||||
| Address2: | SUITE 3170 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503143017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152830463 | ||||||||
| FaxNumber: | 5152830794 | ||||||||
| Practice Location | |||||||||
| Address1: | 411 LAUREL ST | ||||||||
| Address2: | SUITE 3170 | ||||||||
| City: | DES MOINES | ||||||||
| State: | IA | ||||||||
| PostalCode: | 503143017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5152830463 | ||||||||
| FaxNumber: | 5152830794 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/30/2008 | ||||||||
| LastUpdateDate: | 06/12/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4462 | IA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.