Provider Demographics
NPI:1235236639
Name:ROSENMAN, KENNETH DANIEL (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:DANIEL
Last Name:ROSENMAN
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 1:804 SERVICE RD STE A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-353-4830
Mailing Address - Fax:517-355-2134
Practice Address - Street 1:4650 S HAGADORN RD STE 100
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-5386
Practice Address - Country:US
Practice Address - Phone:517-353-4830
Practice Address - Fax:517-355-2134
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010512302083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1910600Medicaid
0C36019021Medicare ID - Type Unspecified
MIC36082012Medicare PIN
MIE61934Medicare UPIN
MI0C36082012Medicare ID - Type Unspecified