Provider Demographics
NPI:1972064061
Name:GOSLINOSKI, LOIS ROSE (DO)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:ROSE
Last Name:GOSLINOSKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1624
Mailing Address - Country:US
Mailing Address - Phone:703-346-6094
Mailing Address - Fax:231-723-1795
Practice Address - Street 1:415 3RD ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1624
Practice Address - Country:US
Practice Address - Phone:703-346-6094
Practice Address - Fax:231-723-1795
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012840207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology