Basic Information
| Provider Information | |||||||||
| NPI: | 1356386387 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROLLISON | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 CAMPUS DRIVE | ||||||||
| Address2: | |||||||||
| City: | HANCOCK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499301569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064831050 | ||||||||
| FaxNumber: | 9064831270 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 CAMPUS DRIVE | ||||||||
| Address2: | SUITE 3 | ||||||||
| City: | HANCOCK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 499301569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9064831050 | ||||||||
| FaxNumber: | 9064831270 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2006 | ||||||||
| LastUpdateDate: | 06/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 5101012731 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 92318 | MT | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 382626196 | 01 | MI | TRICARE HEALTH NET | OTHER | 4684825 | 05 | MI | MEDICAID | 0P10950 | 01 | MA | TRAVELERS | OTHER | H76548 | 01 | MI | HEALTH ALLIANCE PLAN | OTHER | 7662412 | 01 | MI | AETNA | OTHER | 0C16002133 | 01 | MI | MEDICARE PTAN | OTHER | 382626196 | 01 | MI | PPOM | OTHER | 0649513 | 01 | MI | CIGNA | OTHER | 0C16002 | 01 | MI | MEDICARE GROUP PTAN | OTHER | 160B511630 | 01 | MI | BLUE CARE NETWORK | OTHER | 1652510814 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | CR012731 | 01 | MI | BLUE CARE NETWORK | OTHER | 0999854 | 01 | MI | HEALTH PLUS OF MICHIGAN | OTHER | 4684825 | 01 | MI | MOLINA HEALTH CARE | OTHER | CR012731 | 01 | MI | BLUE CROSS BLUE SHIELD | OTHER | 16814 | 01 | MI | MCARE | OTHER |