Healthcare Provider Details

I. General information

NPI: 1508720525
Provider Name (Legal Business Name): ROSEMARY BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2025
Last Update Date: 12/13/2025
Certification Date: 12/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 WHITES RD
KALAMAZOO MI
49008-2836
US

IV. Provider business mailing address

1400 WHITES RD
KALAMAZOO MI
49008-2836
US

V. Phone/Fax

Practice location:
  • Phone: 269-223-0311
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number5601013560
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: