Provider Demographics
NPI:1841283587
Name:ROSEN, LEONARD J (MD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:J
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30538 FOX CLUB DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-1988
Mailing Address - Country:US
Mailing Address - Phone:734-365-3135
Mailing Address - Fax:
Practice Address - Street 1:30538 FOX CLUB DR
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-1988
Practice Address - Country:US
Practice Address - Phone:734-365-3135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010330832084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1089146Medicaid
MI1089146Medicaid
MIQ24656002Medicare PIN
MIA74671Medicare UPIN