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NPI Code Detail

MEDICARE: COLE ROTTEGER

MEDICARE: COLE ROTTEGER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramMI

General Provider Information

NPI Number : 1104767839
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLE ROTTEGER
Provider Business Mailing Address
First Line : 422 COVENTRY LN
Second Line :
City : MASON
State : MI
Zip : 48854-1159
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2799 W GRAND BLVD
Second Line :
City : DETROIT
State : MI
Zip : 48202-2608
Country : US
Telephone Number : 313-916-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2026
Last Update Date : 04/06/2026

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Directions to “ COLE ROTTEGER ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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