Provider Demographics
NPI:1386407401
Name:ROSENMAYER, TODD R (CCAR)
Entity type:Individual
Prefix:MR
First Name:TODD
Middle Name:R
Last Name:ROSENMAYER
Suffix:
Gender:M
Credentials:CCAR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31581 GRATIOT AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4528
Mailing Address - Country:US
Mailing Address - Phone:586-783-4802
Mailing Address - Fax:
Practice Address - Street 1:31581 GRATIOT AVE
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4528
Practice Address - Country:US
Practice Address - Phone:586-783-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-01
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist