Provider Demographics
NPI:1063407955
Name:ROSIK, ANDREA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:MARIE
Last Name:ROSIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43151 DALCOMA DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-6306
Mailing Address - Country:US
Mailing Address - Phone:586-286-8720
Mailing Address - Fax:586-649-6699
Practice Address - Street 1:50505 SCHOENHERR RD
Practice Address - Street 2:SUITE 325
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48315-3140
Practice Address - Country:US
Practice Address - Phone:586-580-1001
Practice Address - Fax:586-580-9289
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004355207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q32772Medicare UPIN
N84320015Medicare ID - Type Unspecified