Provider Demographics
NPI:1689628927
Name:ROSEMA, KATHY (DO)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ROSEMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 S GETTY STREET
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1207
Mailing Address - Country:US
Mailing Address - Phone:231-739-9315
Mailing Address - Fax:231-737-1808
Practice Address - Street 1:119 S STATE ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MI
Practice Address - Zip Code:49455-1243
Practice Address - Country:US
Practice Address - Phone:231-861-2130
Practice Address - Fax:231-861-4964
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101009504207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4267920Medicaid
MI4267920Medicaid
MIE26257Medicare UPIN