Healthcare Provider Details

I. General information

NPI: 1518081116
Provider Name (Legal Business Name): ROBERT A ZOLTOWSKI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 01/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 FOREST AVE SUITE 5B
PLYMOUTH MI
48170-1780
US

IV. Provider business mailing address

580 FOREST AVE SUITE 5B
PLYMOUTH MI
48170-1780
US

V. Phone/Fax

Practice location:
  • Phone: 734-416-0780
  • Fax: 734-404-6280
Mailing address:
  • Phone: 734-416-0780
  • Fax: 734-404-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number5101011438
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: