Individual
KEITH ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3916 CHARLEVOIX AVE, SUITE B, PETOSKEY, MI 49770-9722
(231) 348-1995
(231) 347-3223
Mailing address
PO BOX 34, PETOSKEY, MI 49770-0034
(231) 348-1995
(231) 347-3223
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
4301064558
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2502410522
BCBS
MI
05
—
4692460-10
—
MI
05
—
5176947
—
MI
Enumeration date
08/09/2006
Last updated
03/14/2014
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