Healthcare Provider Details

I. General information

NPI: 1609793892
Provider Name (Legal Business Name): EDUARD ROTTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 W. 13 MILE ROAD
ROYAL OAK MI
48073
US

IV. Provider business mailing address

3601 W. 13 MILE ROAD
ROYAL OAK MI
48073
US

V. Phone/Fax

Practice location:
  • Phone: 248-551-3000
  • Fax:
Mailing address:
  • Phone: 248-551-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4351056658
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: