Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101007652 | MI |
NPI | 1679856421 |
---|---|
Provider Name | Dr. Susan Marie Rose |
First Address | Brighton, MI 48116-1107 |
Second Address | Ann Arbor, MI 48104-5124 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2011 |
Last Update Date | 28/09/2017 |