Provider Demographics
NPI:1093714982
Name:ROSNER, MICHAEL J (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:ROSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 DOCTORS DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28792-7290
Mailing Address - Country:US
Mailing Address - Phone:828-684-1076
Mailing Address - Fax:828-684-7857
Practice Address - Street 1:80 DOCTORS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28792-7290
Practice Address - Country:US
Practice Address - Phone:828-684-1076
Practice Address - Fax:828-684-7857
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN26865Medicaid
NC274201010OtherTRICARE/CHAMPUS
NC891162VMedicaid
NC2279965Medicare ID - Type UnspecifiedINDIVIDUAL PROVIDER #
NC891162VMedicaid