Healthcare Provider Details

I. General information

NPI: 1215631932
Provider Name (Legal Business Name): ERIC MICHAEL ROOSE MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 S MASON MONTGOMERY RD UNIT 201
MASON OH
45040-7892
US

IV. Provider business mailing address

2960 DISNEY ST UNIT 405
CINCINNATI OH
45209-5040
US

V. Phone/Fax

Practice location:
  • Phone: 513-770-0330
  • Fax:
Mailing address:
  • Phone: 330-730-6680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.156507
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: