Provider Demographics
NPI:1669426516
Name:ROSICK, EDWARD R (DO)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:R
Last Name:ROSICK
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:804 SERVICE RD
Mailing Address - Street 2:# A109B
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-7015
Mailing Address - Country:US
Mailing Address - Phone:517-355-1300
Mailing Address - Fax:517-355-1710
Practice Address - Street 1:804 SERVICE RD
Practice Address - Street 2:A235
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7015
Practice Address - Country:US
Practice Address - Phone:517-355-1300
Practice Address - Fax:517-355-1710
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2020-03-18
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Provider Licenses
StateLicense IDTaxonomies
MI51010121162083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4871425Medicaid
MI1669426516Medicaid
MI4871425Medicaid
MI1669426516Medicaid