Provider Demographics
NPI:1336364546
Name:ROSSITER, JAMES L (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:L
Last Name:ROSSITER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2885 N MAYFAIR RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-4404
Mailing Address - Country:US
Mailing Address - Phone:414-771-6780
Mailing Address - Fax:414-238-2424
Practice Address - Street 1:10610 N PORT WASHINGTON ROAD
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092
Practice Address - Country:US
Practice Address - Phone:414-771-6780
Practice Address - Fax:414-238-2424
Is Sole Proprietor?:No
Enumeration Date:2007-04-14
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI40673207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32499600Medicaid
WI32499600Medicaid
F38140Medicare UPIN
WI46225Medicare ID - Type UnspecifiedMEQUON