Healthcare Provider Details

I. General information

NPI: 1154392777
Provider Name (Legal Business Name): DOMINIC D MONTEROSSO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 07/09/2025
Certification Date: 07/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43475 DALCOMA DR STE 100
CLINTON TWP MI
48038-3593
US

IV. Provider business mailing address

3601 W 13 MILE RD ANESTHESIOLOGY DEPT
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 586-263-5043
  • Fax:
Mailing address:
  • Phone: 248-723-1635
  • Fax: 248-723-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101014073
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: