Provider Demographics
NPI:1538179767
Name:ROSENBAUM, CAROLE LYNNETT (DPM)
Entity type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:LYNNETT
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 W BROAD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2331
Mailing Address - Country:US
Mailing Address - Phone:931-854-9222
Mailing Address - Fax:931-854-9902
Practice Address - Street 1:345 W BROAD ST STE 2
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501
Practice Address - Country:US
Practice Address - Phone:931-854-9222
Practice Address - Fax:931-854-9902
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000548213E00000X, 213ES0131X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDPM0000000548OtherPODIATRY LICENSE
TN3351893Medicaid
TN4011516OtherBLUE CROSS BLUE SHIELD
TN0789170001OtherMEDICARE DME
TN480032715OtherMEDICARE RAILROAD
TN621360419OtherTAX ID GROUP
TN895814000OtherCIGNA HEALTHCARE INS
TN0002462OtherNHC HEALTH BENEFIT
TNBR5394161OtherDEA
TN3351893Medicare ID - Type UnspecifiedGROUP
TN621360419OtherTAX ID GROUP
TNBR5394161OtherDEA
TN3353276Medicare ID - Type UnspecifiedINDIVIDUAL
TN480032715OtherMEDICARE RAILROAD
TN0789170001Medicare NSC