Individual
MICHAEL SHANNON ROSCOE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 838-5100
Mailing address
308 W 46TH ST, INDIANAPOLIS, IN 46208-3602
(317) 940-6026
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
10000397A
IN
Other
Enumeration date
07/26/2006
Last updated
01/18/2014
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