Provider Demographics
NPI:1275893976
Name:VASILOFF, ROSANNE D (MD)
Entity type:Individual
Prefix:
First Name:ROSANNE
Middle Name:D
Last Name:VASILOFF
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6490 BLUE STAR HWY
Mailing Address - Street 2:
Mailing Address - City:SAUGATUCK
Mailing Address - State:MI
Mailing Address - Zip Code:49453-9727
Mailing Address - Country:US
Mailing Address - Phone:269-857-3208
Mailing Address - Fax:
Practice Address - Street 1:6490 BLUE STAR HWY
Practice Address - Street 2:
Practice Address - City:SAUGATUCK
Practice Address - State:MI
Practice Address - Zip Code:49453-9727
Practice Address - Country:US
Practice Address - Phone:269-857-3208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301512000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-135981OtherLICENSE