Provider Demographics
NPI:1629093158
Name:ROSBOLT, JAMES PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PAUL
Last Name:ROSBOLT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:26901 BEAUMONT BLVD STE 3D
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-3849
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21400 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48081-1566
Practice Address - Country:US
Practice Address - Phone:586-498-4400
Practice Address - Fax:586-498-4440
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI51010155002083P0500X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine