Provider Demographics
NPI:1609436062
Name:ROSTAM ADULT AND PEDIATRIC MEDICINE MIDLAND PLLC
Entity Type:Organization
Organization Name:ROSTAM ADULT AND PEDIATRIC MEDICINE MIDLAND PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BEHZOD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSTAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-930-6442
Mailing Address - Street 1:801 JOE MANN BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48642
Mailing Address - Country:US
Mailing Address - Phone:248-930-6442
Mailing Address - Fax:
Practice Address - Street 1:801 JOE MANN BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48642
Practice Address - Country:US
Practice Address - Phone:248-930-6442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty