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General NPI Number Information
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NPI Number | 1063692556
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Entity Type | Organization
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Legal Business Name | MATT T ROSENBERG PC
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 214 N WEST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1903
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Country | US
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Telephone | 517-784-9189
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Fax | 517-784-9657
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Provider Business Mailing Address
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Address Line | 214 N WEST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1903
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Country | US
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Telephone | 517-784-9189
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Fax | 517-784-9657
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATT ROSENBERG
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Credential | M.D.
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Telephone | 517-784-9189
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301065227
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License Number State | MI
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