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General NPI Number Information
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NPI Number | 1578596110
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Entity Type | Organization
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Legal Business Name | ELLEN M. ROTBLATT, M.D., P.C.
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 705 SOUTH MAIN STREET SUITE 280
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City | PLYMOUTH
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State | MI
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Zip | 48170-2089
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Country | US
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Telephone | 734-454-3560
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Fax | 734-454-3570
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Provider Business Mailing Address
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Address Line | 705 SOUTH MAIN STREET SUITE 280
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City | PLYMOUTH
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State | MI
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Zip | 48170-2089
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Country | US
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Telephone | 734-454-3560
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Fax | 734-454-3570
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Authorized Official
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Title or Position | PRESIDENT, BOARD CERTIFIED PSYCHIAT
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Name | DR. ELLEN M ROTBLATT
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Credential | M.D.
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Telephone | 734-454-3560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 4301052943
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License Number State | MI
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