Individual
LAURIE A ROUSSEAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
7000 STATE ROUTE 113 E, BERLIN HEIGHTS, OH 44814-9348
(419) 588-2975
(419) 558-2958
Mailing address
1031 PIERCE STREET, SUITE D, SANDUSKY, OH 44870
(419) 557-5541
(419) 557-5542
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101014619
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
114524035
—
MI
Enumeration date
08/31/2006
Last updated
09/12/2012
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