Individual
MICHAEL STEPHEN ROSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2082 MESQUITE AVE, SUITE A106, LAKE HAVASU CITY, AZ 86403-6710
(928) 680-4233
(928) 680-6522
Mailing address
PO BOX 2820, LAKE HAVASU CITY, AZ 86405-2820
(928) 680-4233
(928) 680-6522
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
30884
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2Z2025
HEALTH NET ID #
AZ
05
—
744632
—
AZ
01
—
AZ0767860
BLUE CROSS BLUE SHIELD #
AZ
01
—
DD0594
RAILROAD MEDICARE GROUP #
AZ
Enumeration date
09/14/2006
Last updated
08/05/2008
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