Provider Demographics
NPI:1689658056
Name:ROSEN, LIONEL W (MD)
Entity Type:Individual
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First Name:LIONEL
Middle Name:W
Last Name:ROSEN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:804 SERVICE RD # A109B
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-884-2976
Mailing Address - Fax:517-432-3928
Practice Address - Street 1:909 FEE ROAD ROOM B119
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-3603
Practice Address - Country:US
Practice Address - Phone:517-353-3070
Practice Address - Fax:517-432-3603
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2023-06-23
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Provider Licenses
StateLicense IDTaxonomies
MI43010292682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1689658056Medicaid
MIC36166039Medicare PIN