Healthcare Provider Details

I. General information

NPI: 1235223728
Provider Name (Legal Business Name): PATRICIA L. ROONEY, D.O.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 SPRING ARBOR ROAD SUITE 300
JACKSON MI
49203
US

IV. Provider business mailing address

2575 SPRING ARBOR ROAD SUITE 300
JACKSON MI
49203
US

V. Phone/Fax

Practice location:
  • Phone: 517-783-6290
  • Fax: 517-783-3753
Mailing address:
  • Phone: 517-783-6290
  • Fax: 517-783-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number5101013687
License Number StateMI

VIII. Authorized Official

Name: DR. PATRICIA L ROONEY
Title or Position: OWNER
Credential: D.O.
Phone: 517-783-6290