MEDICARE: DR. ROMAN IVAN CZUBATYJ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	4301090701	MI
2	332900000X	Non-Pharmacy Dispensing Site	5101009426	MI

General Provider Information

NPI Number	:	1972797892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROMAN IVAN CZUBATYJ M.D.

Provider Business Mailing Address
First Line	:	1701 SOUTH BOULEVARD EAST
Second Line	:	SUITE 140
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-1804
Country	:	US
Telephone Number	:	248-853-0803
Fax Number	:	248-852-5859

Provider Business Practice Location Address
First Line	:	1701 SOUTH BLVD E STE 110
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48307-6118
Country	:	US
Telephone Number	:	248-853-0803
Fax Number	:	248-852-5859

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	07/31/2025

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