Individual
MICHAEL P ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAT
Contact information
Practice address
735 HIGHGROVE PL, ROCKFORD, IL 61108-2520
(815) 226-4365
(815) 226-4589
Mailing address
3534 N WILTON AVE, APT 1, CHICAGO, IL 60657-1709
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
096001973
IL
Other
Enumeration date
06/14/2007
Last updated
05/20/2008
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