Provider Demographics
NPI:1588907588
Name:ROSINSKI, KELLIE VIGNA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:VIGNA
Last Name:ROSINSKI
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:LEANNE
Other - Last Name:VIGNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16401 N 40TH PL
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-3308
Mailing Address - Country:US
Mailing Address - Phone:206-817-3672
Mailing Address - Fax:
Practice Address - Street 1:16401 N 40TH PL
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032
Practice Address - Country:US
Practice Address - Phone:206-817-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-28
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60585495207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine