| Jack R. Roossien Jr., M.d.p.c. | |
|
15151 Stanton St Suite A West Olive MI 49460-8543 | |
| (616) 296-1020 | |
| (616) 296-1030 |
| Full Name | Jack R. Roossien Jr., M.d.p.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 15151 Stanton St, West Olive, Michigan |
| Authorized Official Name and Position | Jack Richard Roossien (PRESIDENT) |
| Authorized Official Contact | 6162961020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jack R. Roossien Jr., M.d.p.c. 15151 Stanton St Suite A West Olive MI 49460-8543 Ph: (616) 296-1020 | Jack R. Roossien Jr., M.d.p.c. 15151 Stanton St Suite A West Olive MI 49460-8543 Ph: (616) 296-1020 |
| NPI Number | 1740406982 |
|---|---|
| Provider Enumeration Date | 04/17/2007 |
| Last Update Date | 05/27/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1740406982 | NPI | - | NPPES |
| ON13120 | Other | MI | MEDICARE GROUP NUMBER |
| 4214810 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 4301050437 (Michigan) | Primary |