Provider Demographics
NPI:1356386387
Name:ROLLISON, CHARLES E (DO)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:ROLLISON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAMPUS DRIVE
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1050
Mailing Address - Fax:906-483-1270
Practice Address - Street 1:500 CAMPUS DRIVE
Practice Address - Street 2:SUITE 3
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1050
Practice Address - Fax:906-483-1270
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012731207V00000X
MT92318207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382626196OtherTRICARE HEALTH NET
MI4684825Medicaid
MA0P10950OtherTRAVELERS
MIH76548OtherHEALTH ALLIANCE PLAN
MI7662412OtherAETNA
MI0C16002133OtherMEDICARE PTAN
MI382626196OtherPPOM
MI0649513OtherCIGNA
MI0C16002OtherMEDICARE GROUP PTAN
MI160B511630OtherBLUE CARE NETWORK
MI1652510814OtherBLUE CROSS BLUE SHIELD
MICR012731OtherBLUE CARE NETWORK
MI0999854OtherHEALTH PLUS OF MICHIGAN
MI4684825OtherMOLINA HEALTH CARE
MICR012731OtherBLUE CROSS BLUE SHIELD
MI16814OtherMCARE
MI7662412OtherAETNA
MICR012731OtherBLUE CROSS BLUE SHIELD