Individual
MICHAEL A ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1789 SHAWANO AVE, GREEN BAY, WI 54303
(920) 499-1428
(920) 499-5808
Mailing address
PO BOX 3006, GREEN BAY, WI 54303
(920) 499-1428
(920) 499-5808
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
32874-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1018926002
UNITED HEALTHCARE MEDICAI
—
01
—
14448
DEAN HEALTH
—
01
—
300030636
RR MEDICARE
—
05
—
31799500
—
WI
05
—
4723997
—
MI
05
—
4767230
—
MI
01
—
567565
DEAN HEALTH
—
Enumeration date
07/12/2006
Last updated
11/05/2009
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