MEDICARE: DR. ROBERT I MORETSKY D.O.

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
1	207Q00000X	Family Medicine Physician	5101005323	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00237883	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	E26627	OTHER	MI	HAP
3	700H217350	OTHER	MI	BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487638573
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT I MORETSKY D.O.

Provider Business Mailing Address
First Line	:	25600 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1447
Country	:	US
Telephone Number	:	586-777-6170
Fax Number	:	586-777-6582

Provider Business Practice Location Address
First Line	:	25600 SCHOENHERR RD
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48089-1447
Country	:	US
Telephone Number	:	586-777-6170
Fax Number	:	586-777-6582

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	02/16/2011

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