Provider Demographics
NPI:1750365334
Name:PARK, ROSEMARY HAESUNG (MD)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:HAESUNG
Last Name:PARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26850 PROVIDENCE PKWY
Mailing Address - Street 2:SUITE 315
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-1213
Mailing Address - Country:US
Mailing Address - Phone:248-465-4340
Mailing Address - Fax:248-465-4341
Practice Address - Street 1:26850 PROVIDENCE PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-1213
Practice Address - Country:US
Practice Address - Phone:248-465-4340
Practice Address - Fax:248-465-4341
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRP066801207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIC6131OtherM CARE
MI4495579Medicaid
MI4495579Medicaid
MIN70340001Medicare ID - Type Unspecified