Provider Demographics
NPI:1114663077
Name:ROSUNALLY, MUHAMMAD WASSEER (MD)
Entity Type:Individual
Prefix:MR
First Name:MUHAMMAD
Middle Name:WASSEER
Last Name:ROSUNALLY
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 1:1221 E. STATE ST. MILESQUARE LP JOHNSON CENTER
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61104
Mailing Address - Country:US
Mailing Address - Phone:815-972-1000
Mailing Address - Fax:815-972-1086
Practice Address - Street 1:1221 E. STATE ST. MILESQUARE LP JOHNSON CENTER
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61104
Practice Address - Country:US
Practice Address - Phone:815-972-1000
Practice Address - Fax:815-972-1086
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program