Healthcare Provider Details

I. General information

NPI: 1174969257
Provider Name (Legal Business Name): MONICA WOLL ROSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MONICA LESLIE WOLL M.D.

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 EAST MEDICAL CENTER DR 9TH FLOOR VONVOIGTLANDER WOMENS HOSP RECP B
ANN ARBOR MI
48109-4276
US

IV. Provider business mailing address

3621 SOUTH STATE STREET 700 KMS PLACE
ANN ARBOR MI
48108
US

V. Phone/Fax

Practice location:
  • Phone: 734-763-6295
  • Fax:
Mailing address:
  • Phone: 734-936-2047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301102794
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: