Healthcare Provider Details

I. General information

NPI: 1487634986
Provider Name (Legal Business Name): RONALD I ROTHENBERG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 W MAPLE RD STE 100
CLAWSON MI
48017
US

IV. Provider business mailing address

909 W MAPLE RD STE 100
CLAWSON MI
48017
US

V. Phone/Fax

Practice location:
  • Phone: 248-435-2028
  • Fax: 248-435-2099
Mailing address:
  • Phone: 248-435-2028
  • Fax: 248-435-2099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101005522
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: