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General NPI Number Information
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NPI Number | 1477058949
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Entity Type | Individual
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Provider Name | IAN ROSLAWSKI DO
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Gender | Male
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Dates
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Enumeration Date | 03/27/2018
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 10010 KENNERLY RD
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2106
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Country | US
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Telephone | 314-525-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 42D MEDICAL GROUP, 300 S. TWINING ST BLDG 760
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City | MAXWELL AFB
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State | AL
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Zip | 36112
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Country | US
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Telephone | 334-953-3368
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Fax | 334-953-8607
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 2024045914
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License Number State | MO
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