Healthcare Provider Details

I. General information

NPI: 1053376384
Provider Name (Legal Business Name): ROBERT R DILORETO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 LOTHROP RD
GROSSE POINTE FARMS MI
48236-3527
US

IV. Provider business mailing address

181 LOTHROP RD
GROSSE POINTE FARMS MI
48236-3527
US

V. Phone/Fax

Practice location:
  • Phone: 313-881-3812
  • Fax:
Mailing address:
  • Phone: 313-881-3812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number4301036620
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: