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General NPI Number Information
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NPI Number | 1962018671
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Entity Type | Individual
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Provider Name | JOSHUA ROOSE DO
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Gender | Male
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Dates
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Enumeration Date | 09/17/2020
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Last Update Date | 06/26/2025
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Provider Practice Location Address
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Address Line | 22894 19 MILE RD
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City | TUSTIN
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State | MI
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Zip | 49688-8059
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Country | US
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Telephone | 231-884-4462
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Fax |
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Provider Business Mailing Address
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Address Line | 22894 19 MILE RD
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City | TUSTIN
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State | MI
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Zip | 49688-8059
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Country | US
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Telephone | 231-884-4462
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 58.032115
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License Number State | OH
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