Individual
MARK M ROESER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-3300
(810) 765-8169
Mailing address
6071 W OUTER DR, DETROIT, MI 48235-2624
(313) 966-3300
(810) 765-8169
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1044525
NCCPA
MI
Enumeration date
06/25/2006
Last updated
07/25/2008
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