Healthcare Provider Details

I. General information

NPI: 1750365334
Provider Name (Legal Business Name): ROSEMARY HAESUNG PARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26850 PROVIDENCE PKWY SUITE 315
NOVI MI
48374-1213
US

IV. Provider business mailing address

26850 PROVIDENCE PKWY SUITE 315
NOVI MI
48374-1213
US

V. Phone/Fax

Practice location:
  • Phone: 248-465-4340
  • Fax: 248-465-4341
Mailing address:
  • Phone: 248-465-4340
  • Fax: 248-465-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRP066801
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: