Provider Demographics
NPI:1245281633
Name:MORELL, ROSS JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:JOSEPH
Last Name:MORELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5865 WHITMORE LAKE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-1945
Mailing Address - Country:US
Mailing Address - Phone:810-227-1200
Mailing Address - Fax:
Practice Address - Street 1:5865 WHITMORE LAKE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-1945
Practice Address - Country:US
Practice Address - Phone:810-227-1200
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRM008704207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26638Medicare UPIN
MI5471514Medicare ID - Type Unspecified