Healthcare Provider Details

I. General information

NPI: 1336364546
Provider Name (Legal Business Name): JAMES L ROSSITER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2007
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10610 N PORT WASHINGTON ROAD
MEQUON WI
53092
US

IV. Provider business mailing address

2885 N MAYFAIR RD
MILWAUKEE WI
53222-4404
US

V. Phone/Fax

Practice location:
  • Phone: 414-771-6780
  • Fax: 414-238-2424
Mailing address:
  • Phone: 414-771-6780
  • Fax: 414-238-2424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number40673
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: