Provider Demographics
NPI:1326507179
Name:ROSSIO, SHANNON KATHLEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:KATHLEEN
Last Name:ROSSIO
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 655
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-0655
Mailing Address - Country:US
Mailing Address - Phone:989-736-8157
Mailing Address - Fax:989-358-3763
Practice Address - Street 1:6135 CRESSY ST
Practice Address - Street 2:
Practice Address - City:INDIAN RIVER
Practice Address - State:MI
Practice Address - Zip Code:49749-5151
Practice Address - Country:US
Practice Address - Phone:231-238-8908
Practice Address - Fax:231-238-4419
Is Sole Proprietor?:No
Enumeration Date:2019-03-19
Last Update Date:2023-02-06
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Provider Licenses
StateLicense IDTaxonomies
MI4301508012207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine