Healthcare Provider Details

I. General information

NPI: 1467617365
Provider Name (Legal Business Name): ROOPAL A CHITNIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 05/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11080 HALL RD
STERLING HEIGHTS MI
48314-1511
US

IV. Provider business mailing address

11080 HALL RD
STERLING HEIGHTS MI
48314-1511
US

V. Phone/Fax

Practice location:
  • Phone: 586-254-7200
  • Fax:
Mailing address:
  • Phone: 586-254-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1601000123
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: