Individual
LISA DE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
22101 MOROSS RD, DETROIT, MI 48236-2148
(313) 699-0819
Mailing address
22101 MOROSS RD, DETROIT, MI 48236-2148
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
4301514852
MI
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/25/2019
Last updated
06/23/2025
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