Provider Demographics
NPI:1184659591
Name:ROSSING, MARK H (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:H
Last Name:ROSSING
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:888 THACKERAY TRAIL
Mailing Address - Street 2:#211
Mailing Address - City:OCONOMOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:53066-4641
Mailing Address - Country:US
Mailing Address - Phone:262-567-1122
Mailing Address - Fax:262-567-1481
Practice Address - Street 1:888 THACKERAY TRAIL
Practice Address - Street 2:#211
Practice Address - City:OCONOMOWOC
Practice Address - State:WI
Practice Address - Zip Code:53066-4641
Practice Address - Country:US
Practice Address - Phone:262-567-1122
Practice Address - Fax:262-567-1481
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI334252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31875700Medicaid
F35940Medicare UPIN
WI46033Medicare ID - Type Unspecified