Individual
DR. JACK RICHARD ROOSSIEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
15151 STANTON ST, SUITE A, WEST OLIVE, MI 49460-8543
(616) 296-1020
(616) 296-1030
Mailing address
PO BOX 1848, MUSKEGON, MI 49443-1848
(866) 611-1612
(231) 728-4789
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
JR050437
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1184610669
—
MI
05
—
4214810
—
MI
01
—
ON13120
MEDICARE GROUP NUMBER
MI
Enumeration date
09/21/2005
Last updated
06/07/2019
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