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General NPI Number Information
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NPI Number | 1063422285
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Entity Type | Individual
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Provider Name | KEITH ROSE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/09/2006
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Last Update Date | 03/14/2014
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Provider Practice Location Address
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Address Line | 3916 CHARLEVOIX AVE SUITE B
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City | PETOSKEY
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State | MI
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Zip | 49770-9722
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Country | US
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Telephone | 231-348-1995
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Fax | 231-347-3223
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Provider Business Mailing Address
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Address Line | PO BOX 34
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City | PETOSKEY
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State | MI
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Zip | 49770-0034
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Country | US
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Telephone | 231-348-1995
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Fax | 231-347-3223
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 4301064558
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License Number State | MI
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