Individual
MICHELE ROULLET BAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
600 GRESHAM DR, DEPARTMENT OF PATHOLOGY, NORFOLK, VA 23507-1904
(757) 388-3221
(757) 388-3799
Mailing address
PO BOX 20452, PSMG-CREDENTIALING, COLUMBUS, OH 43220-0452
(614) 442-2406
(614) 442-2410
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
0101243457
VA
Other
Enumeration date
01/02/2007
Last updated
08/16/2017
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