MEDICARE: LEONARD J. ROSEN, M.D. PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0850X	Adult Mental Health Clinic/Center	4301033083	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LR033083	OTHER	MI	LIC #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	2608282111	OTHER	MI	BCBS #

General Provider Information

NPI Number	:	1124059951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEONARD J. ROSEN, M.D. PC

Provider Business Mailing Address
First Line	:	30538 FOX CLUB DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1988
Country	:	US
Telephone Number	:	734-246-7447
Fax Number	:

Provider Business Practice Location Address
First Line	:	30538 FOX CLUB DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1988
Country	:	US
Telephone Number	:	734-246-7447
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LEONARD J ROSEN
Credential	:	M.D
Telephone Number	:	734-246-7477

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/01/2011

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