Healthcare Provider Details

I. General information

NPI: 1447415526
Provider Name (Legal Business Name): ROHIT A MARAWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2008
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 SAINT ANTOINE ST STE 8A&8B
DETROIT MI
48201-2153
US

IV. Provider business mailing address

1560 E MAPLE RD SUITE 400 - CREDENTIALING DEPARTMENT
TROY MI
48083-1138
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-4275
  • Fax: 313-745-4468
Mailing address:
  • Phone: 313-745-4275
  • Fax: 313-745-4468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number16014
License Number StateNH
# 2
Primary TaxonomyY
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number4301110967
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number4301110967
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: