Provider Demographics
NPI:1558350942
Name:ROSSOF, ARTHUR H (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:H
Last Name:ROSSOF
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:MI
Mailing Address - Zip Code:49406-0729
Mailing Address - Country:US
Mailing Address - Phone:269-857-4352
Mailing Address - Fax:
Practice Address - Street 1:2679 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:FENNVILLE
Practice Address - State:MI
Practice Address - Zip Code:49408-8649
Practice Address - Country:US
Practice Address - Phone:269-857-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036042916207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036042916Medicaid