Provider Demographics
NPI:1700843257
Name:ROSKOS, STEVEN ERIC (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:ERIC
Last Name:ROSKOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 LANSING RD STE 1
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8442
Mailing Address - Country:US
Mailing Address - Phone:517-258-0328
Mailing Address - Fax:517-201-1173
Practice Address - Street 1:1699 LANSING RD STE 1
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8442
Practice Address - Country:US
Practice Address - Phone:517-258-0328
Practice Address - Fax:517-201-1173
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2021-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3812583Medicaid
MI5208610Medicaid
MI1700843257Medicaid
TN4091922OtherBLUE CROSS/BLUE SHIELD
TNP00171051OtherRAILROAD MEDICARE
MI0C36088Medicare PIN
MI5208610Medicaid
TN3812583Medicaid