Provider Demographics
NPI:1376537142
Name:CHOI, ROSELLEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSELLEN
Middle Name:S
Last Name:CHOI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF PEDIATRICS
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-337-7050
Mailing Address - Fax:414-337-7020
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF PEDIATRICS
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-337-7050
Practice Address - Fax:414-337-7020
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-109641208000000X
WI66033208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036109641Medicaid
WI1376537142Medicaid
IL036109641Medicaid