Provider Demographics
NPI:1689738858
Name:PATRICIA L. ROONEY, D.O.
Entity Type:Organization
Organization Name:PATRICIA L. ROONEY, D.O.
Other - Org Name:PATRICIA L. ROONEY, D.O.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-783-6290
Mailing Address - Street 1:2575 SPRING ARBOR RD STE 300
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49203-3652
Mailing Address - Country:US
Mailing Address - Phone:517-783-6290
Mailing Address - Fax:517-784-3753
Practice Address - Street 1:2575 SPRING ARBOR RD STE 300
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49203-3652
Practice Address - Country:US
Practice Address - Phone:517-783-6290
Practice Address - Fax:517-784-3753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013687208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOM68220Medicare ID - Type UnspecifiedMEDICARE