Healthcare Provider Details

I. General information

NPI: 1184688483
Provider Name (Legal Business Name): MICHAEL RONTAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 02/03/2021
Certification Date: 02/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30701 WOODWARD AVE STE 200
ROYAL OAK MI
48073-0990
US

IV. Provider business mailing address

30701 WOODWARD AVE STE 200
ROYAL OAK MI
48073-0990
US

V. Phone/Fax

Practice location:
  • Phone: 248-737-4030
  • Fax: 248-307-7873
Mailing address:
  • Phone: 248-737-4030
  • Fax: 248-307-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number4301027047
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: