Healthcare Provider Details

I. General information

NPI: 1285614974
Provider Name (Legal Business Name): RICHARD A ROVIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 12/13/2021
Certification Date: 12/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 W COLLEGE AVE
MARQUETTE MI
49855-2705
US

IV. Provider business mailing address

2837 US HIGHWAY 41 W
MARQUETTE MI
49855-2252
US

V. Phone/Fax

Practice location:
  • Phone: 906-225-4575
  • Fax: 906-225-4578
Mailing address:
  • Phone: 906-225-3964
  • Fax: 906-226-3875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301057445
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: