Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 5601004355 | MI |
NPI | 1063407955 |
---|---|
Provider Name | Andrea Marie Rosik |
First Address | Clinton Township, MI 48038-6306 |
Second Address | Shelby Township, MI 48315-3140 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/09/2005 |
Last Update Date | 20/05/2015 |