Provider Demographics
NPI:1639237522
Name:DEMCZUK, ROSE H (MD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:H
Last Name:DEMCZUK
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 1:7267 TAFT LANE
Mailing Address - Street 2:
Mailing Address - City:BRUCE TWP.
Mailing Address - State:MI
Mailing Address - Zip Code:48065
Mailing Address - Country:US
Mailing Address - Phone:586-531-9845
Mailing Address - Fax:
Practice Address - Street 1:1460 WALTON BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48309-1768
Practice Address - Country:US
Practice Address - Phone:248-688-8057
Practice Address - Fax:248-601-9991
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010581052084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000013317OtherPOLICY #
0000013317OtherPOLICY #
MI0M10460005Medicare ID - Type Unspecified