MEDICARE: DR. LEONARD J ROSEN M.D.

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	2084P0800X	Psychiatry Physician	4301033083	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841283587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEONARD J ROSEN M.D.

Provider Business Mailing Address
First Line	:	30538 FOX CLUB DR
Second Line	:
City	:	FARMINGTON HILLS
State	:	MI
Zip	:	48331-1988
Country	:	US
Telephone Number	:	734-365-3135
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	:	734-365-3135
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2005
Last Update Date	:	12/26/2012

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