Provider Demographics
NPI:1679932206
Name:ROSEN-WASSERMAN, KAREN ALLYSE (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ALLYSE
Last Name:ROSEN-WASSERMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-5400
Mailing Address - Country:US
Mailing Address - Phone:810-989-0000
Mailing Address - Fax:810-989-5266
Practice Address - Street 1:615 PINE ST
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-5400
Practice Address - Country:US
Practice Address - Phone:810-989-0000
Practice Address - Fax:810-989-5266
Is Sole Proprietor?:No
Enumeration Date:2016-02-10
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010263652081P2900X
AZ0082132081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine