Healthcare Provider Details

I. General information

NPI: 1003267824
Provider Name (Legal Business Name): ROBERT MICHAEL CAMILLETTI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 GENOA BUSINESS PARK DR STE 200
BRIGHTON MI
48114-7005
US

IV. Provider business mailing address

24 FRANK LLOYD WRIGHT DR LBBY J2000
ANN ARBOR MI
48105-9484
US

V. Phone/Fax

Practice location:
  • Phone: 810-494-6840
  • Fax: 810-494-6841
Mailing address:
  • Phone: 734-747-6766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101024502
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: