Provider Demographics
NPI:1871570564
Name:ROSOL, STANLEY J (DO)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:J
Last Name:ROSOL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:6269 MEREFORD CT
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-9213
Mailing Address - Country:US
Mailing Address - Phone:419-885-0000
Mailing Address - Fax:419-885-0000
Practice Address - Street 1:6269 MEREFORD CT
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-9213
Practice Address - Country:US
Practice Address - Phone:419-885-0000
Practice Address - Fax:419-885-0000
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHOH34-00-2631208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0345997Medicaid
OH0345997Medicaid
OH0438665Medicare PIN