Provider Demographics
NPI:1598735169
Name:ROSSMANN, MICHELLE DEBRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:DEBRA
Last Name:ROSSMANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29215 CHESTNUT CT
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2598
Mailing Address - Country:US
Mailing Address - Phone:248-973-9086
Mailing Address - Fax:
Practice Address - Street 1:29215 CHESTNUT CT
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2598
Practice Address - Country:US
Practice Address - Phone:248-417-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA077212002085R0202X, 2085R0204X
NY1731452085R0202X, 2085R0204X
MI43010687612085R0202X, 2085N0904X
IL0361034472085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7617078Medicaid
NC7617078Medicaid
MIMI1840004Medicare PIN