Individual
MATTHEW K ROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1105 6TH ST, TRAVERSE CITY, MI 49684-2345
(231) 935-5000
Mailing address
625 W 7TH ST, TRAVERSE CITY, MI 49684-2434
(231) 995-0215
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601002557
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5601002557
STATE LICENSE NUMBER
MI
Enumeration date
08/25/2006
Last updated
08/01/2019
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