Jack R. Roossien Jr., M.d.p.c. | |
15151 Stanton St Suite A West Olive MI 49460-8543 | |
(616) 296-1020 | |
(616) 296-1030 |
Full Name | Jack R. Roossien Jr., M.d.p.c. |
---|---|
Speciality | Family Medicine |
Location | 15151 Stanton St, West Olive, Michigan |
Authorized Official Name and Position | Jack Richard Roossien (PRESIDENT) |
Authorized Official Contact | 6162961020 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Jack R. Roossien Jr., M.d.p.c. 15151 Stanton St Suite A West Olive MI 49460-8543 Ph: (616) 296-1020 | Jack R. Roossien Jr., M.d.p.c. 15151 Stanton St Suite A West Olive MI 49460-8543 Ph: (616) 296-1020 |
NPI Number | 1740406982 |
---|---|
Provider Enumeration Date | 04/17/2007 |
Last Update Date | 05/27/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1740406982 | NPI | - | NPPES |
ON13120 | Other | MI | MEDICARE GROUP NUMBER |
4214810 | Medicaid | MI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | 4301050437 (Michigan) | Primary |