Provider Demographics
NPI:1891760997
Name:ROSELLA, JOHN ANDREW (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:ROSELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1265 N MILFORD RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48381
Mailing Address - Country:US
Mailing Address - Phone:248-685-3600
Mailing Address - Fax:248-685-0057
Practice Address - Street 1:1265 N MILFORD RD
Practice Address - Street 2:MILFORD FAMILY PRACTICE
Practice Address - City:MILFORD
Practice Address - State:MI
Practice Address - Zip Code:48381
Practice Address - Country:US
Practice Address - Phone:248-685-3600
Practice Address - Fax:248-685-0057
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MIJR007732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OM91890001Medicare ID - Type Unspecified
E37374Medicare UPIN