Provider Demographics
NPI:1427552728
Name:CHARLES, ROSETTE MICHELLE (MD)
Entity type:Individual
Prefix:DR
First Name:ROSETTE
Middle Name:MICHELLE
Last Name:CHARLES
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 N STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33313-2778
Mailing Address - Country:US
Mailing Address - Phone:954-714-1264
Mailing Address - Fax:954-320-7142
Practice Address - Street 1:2589 N STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-2778
Practice Address - Country:US
Practice Address - Phone:954-714-1264
Practice Address - Fax:954-320-7142
Is Sole Proprietor?:No
Enumeration Date:2018-03-21
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME151429207R00000X
WI84003207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1427552728Medicaid