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General NPI Number Information
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NPI Number | 1649918384
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Entity Type | Individual
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Provider Name | ANTHONY DOMENIC ROTONDO DO
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Gender | Male
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Dates
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Enumeration Date | 05/23/2022
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Last Update Date | 10/06/2025
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Provider Practice Location Address
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Address Line | 201 3RD ST
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City | BELLEVILLE
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State | MI
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Zip | 48111-2605
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Country | US
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Telephone | 734-697-9065
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Fax |
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Provider Business Mailing Address
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Address Line | 26901 BEAUMONT BLVD STE 3D
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City | SOUTHFIELD
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State | MI
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Zip | 48033-3849
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 5101028600
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License Number State | MI
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