Healthcare Provider Details

I. General information

NPI: 1801999131
Provider Name (Legal Business Name): MITCHEL GLENN ROSSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 LOWELL BLVD
DENVER CO
80204-1559
US

IV. Provider business mailing address

DEPT 1057
DENVER CO
80291-1057
US

V. Phone/Fax

Practice location:
  • Phone: 303-825-1234
  • Fax:
Mailing address:
  • Phone: 303-486-5504
  • Fax: 303-486-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number27230
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: