Provider Demographics
NPI:1619357324
Name:ROLSTON, BRICE (MD)
Entity type:Individual
Prefix:
First Name:BRICE
Middle Name:
Last Name:ROLSTON
Suffix:
Gender:M
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:PO BOX 1091
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48106-1091
Mailing Address - Country:US
Mailing Address - Phone:734-623-9070
Mailing Address - Fax:734-763-9298
Practice Address - Street 1:401 N HOOPER ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1476
Practice Address - Country:US
Practice Address - Phone:734-623-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-08
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.136921207P00000X
MI4301108010207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine