Healthcare Provider Details

I. General information

NPI: 1275893976
Provider Name (Legal Business Name): ROSANNE D VASILOFF MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2012
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 BLUE STAR HWY
SAUGATUCK MI
49453-9727
US

IV. Provider business mailing address

6490 BLUE STAR HWY
SAUGATUCK MI
49453-9727
US

V. Phone/Fax

Practice location:
  • Phone: 269-857-3208
  • Fax:
Mailing address:
  • Phone: 269-857-3208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301512000
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: