Healthcare Provider Details

I. General information

NPI: 1902847270
Provider Name (Legal Business Name): MARK S ROSNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 E HURON RIVER DR
ANN ARBOR MI
48106
US

IV. Provider business mailing address

8530 PINE COVE DR
COMMERCE TOWNSHIP MI
48382-4455
US

V. Phone/Fax

Practice location:
  • Phone: 734-712-3456
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number049299
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: