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General NPI Number Information
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NPI Number | 1700045317
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Entity Type | Individual
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Provider Name | MEDARDO RICHARD MAROTO M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2008
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Last Update Date | 10/31/2024
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Provider Practice Location Address
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Address Line | 221 MICHIGAN ST NE STE 400
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City | GRAND RAPIDS
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State | MI
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Zip | 49503-2543
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Country | US
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Telephone | 616-486-9600
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Fax |
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Provider Business Mailing Address
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Address Line | 1335 HONEY CREEK AVE NE
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City | ADA
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State | MI
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Zip | 49301-9577
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Country | US
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Telephone | 313-737-3684
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 125-051953
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | N3165
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 01095101A
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License Number State | IN
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Taxonomy #4
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | MD60004075
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 4301082076
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License Number State | MI
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