Organization
JACK R. ROOSSIEN JR., M.D.P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK RICHARD ROOSSIEN JR. M.D. (PRESIDENT)
(616) 296-1020
Entity
Organization
Contact information
Practice address
15151 STANTON ST, SUITE A, WEST OLIVE, MI 49460-8543
(616) 296-1020
(616) 296-1030
Mailing address
15151 STANTON ST, SUITE A, WEST OLIVE, MI 49460-8543
(616) 296-1020
(616) 296-1030
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
4301050437
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4214810
—
MI
01
—
ON13120
MEDICARE GROUP NUMBER
MI
Enumeration date
04/17/2007
Last updated
05/27/2008
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