Healthcare Provider Details

I. General information

NPI: 1689625030
Provider Name (Legal Business Name): ROBERT L ROTY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 MONROE RD
DURAND MI
48429-1000
US

IV. Provider business mailing address

826 W KING ST PO BOX 456
OWOSSO MI
48867-2120
US

V. Phone/Fax

Practice location:
  • Phone: 989-729-6353
  • Fax:
Mailing address:
  • Phone: 989-729-6353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301025299
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: