Gabriel Boladele Rosanwo, MD is a medicare enrolled "Obstetrics & Gynecology" physician in Altoona, Wisconsin. His current practice location is
3119 Woodman Drive, Prevea Health, Altoona, Wisconsin. You can reach out to his office (for appointments etc.) via phone at
(920) 496-4700.
Gabriel Boladele Rosanwo is licensed to practice in Illinois (license number 036104578) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1598740466.
Physician's Profile
| Full Name | Gabriel Boladele Rosanwo |
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| Gender | Male |
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| Speciality | Obstetrics & Gynecology |
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| Location | 3119 Woodman Drive, Altoona, Wisconsin |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1598740466
- Provider Enumeration Date: 12/13/2005
- Last Update Date: 11/08/2022
Medicare PECOS Information:
- PECOS PAC ID: 5496774804
- Enrollment ID: I20051115000723
Medical Identifiers
Medical identifiers for Gabriel Boladele Rosanwo such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1598740466 | NPI | - | NPPES |
| 0053655 | Medicaid | OH | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207Q00000X | Family Medicine | 036104578 (Illinois) | Secondary |
| 207V00000X | Obstetrics & Gynecology | 01080180A (Indiana) | Secondary |
| 207V00000X | Obstetrics & Gynecology | 036104578 (Illinois) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Gabriel Boladele Rosanwo allows following entities to bill medicare on his behalf.
| Entity Name | Obhg Illinois Sc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1700107216
PECOS PAC ID: 7810179702
Enrollment ID: O20110314001065 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Gabriel Boladele Rosanwo is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Gabriel Boladele Rosanwo, MD
17 Rainier Cir,
South Barrington, IL 60010-9440
Ph: (630) 337-4445 | Gabriel Boladele Rosanwo, MD
3119 Woodman Drive, Prevea Health,
Altoona, WI 54720-2668
Ph: (920) 496-4700 |
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