Provider Demographics
NPI:1528094257
Name:ROZELLE, RICHARD W (DPM)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:W
Last Name:ROZELLE
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4540 KALAMAZOO AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENTWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:49508-4625
Mailing Address - Country:US
Mailing Address - Phone:616-281-0666
Mailing Address - Fax:616-281-0752
Practice Address - Street 1:5175 PLAINFIELD AVE NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49525-1048
Practice Address - Country:US
Practice Address - Phone:616-363-9833
Practice Address - Fax:616-363-9701
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5901001069213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1266510002OtherADMINISTAR
MI3506847Medicaid
MI480026387OtherRAILROAD MEDICARE
MI3506847Medicaid
MI480026387OtherRAILROAD MEDICARE