Provider Demographics
NPI:1821044280
Name:ROSEL, MARYELLEN WALTER (DO)
Entity Type:Individual
Prefix:DR
First Name:MARYELLEN
Middle Name:WALTER
Last Name:ROSEL
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1560 E SHERMAN BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49444-1854
Mailing Address - Country:US
Mailing Address - Phone:231-672-3883
Mailing Address - Fax:231-672-3973
Practice Address - Street 1:1500 E SHERMAN BLVD
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1849
Practice Address - Country:US
Practice Address - Phone:231-672-3883
Practice Address - Fax:231-672-3973
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101015664207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4857730-11Medicaid