Provider Demographics
NPI:1871590901
Name:JOHN-ROSMAN, SARINE (MD)
Entity type:Individual
Prefix:
First Name:SARINE
Middle Name:
Last Name:JOHN-ROSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18303 E 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4988
Mailing Address - Country:US
Mailing Address - Phone:586-776-8877
Mailing Address - Fax:586-776-3092
Practice Address - Street 1:18303 E 10 MILE RD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4988
Practice Address - Country:US
Practice Address - Phone:586-776-8877
Practice Address - Fax:586-776-3092
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062285207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7808425OtherAETNA
SJ062285OtherCHAMPUS-CHAMPUS
MICD6196OtherRAILROAD MEDICARE GROUP PIN
SJ062285OtherCOMMERCIAL-COMMERCIAL NUMBER
MI0501411OtherBCBS INDIVIDUAL PIN
MIP0074277OtherRAILROAD MEDICARE PIN
MI0E01050OtherBCBS GROUP PIN
MI328711410Medicaid
060H264410OtherBLUE CROSS-BLUE CROSS
MI4505192-10Medicaid
MI0501411OtherBCBS INDIVIDUAL PIN
MI0M25330Medicare PIN
MI0E01050OtherBCBS GROUP PIN
0H26441045Medicare ID - Type Unspecified