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NPI Code Detail

MEDICARE: DR. DOUGLAS W ROOKSTOOL M.D.

MEDICARE: DR. DOUGLAS W ROOKSTOOL M.D.
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
1207R00000XInternal Medicine Physician01046778AIN
2208M00000XHospitalist Physician01046778AIN

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00465475OTHERINRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1497756563
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DOUGLAS W ROOKSTOOL M.D.
Provider Business Mailing Address
First Line : PO BOX 781076
Second Line :
City : DETROIT
State : MI
Zip : 48278-1076
Country : US
Telephone Number : 317-528-4800
Fax Number : 317-865-1479
Provider Business Practice Location Address
First Line : 1701 S CREASY LN
Second Line :
City : LAFAYETTE
State : IN
Zip : 47905-4972
Country : US
Telephone Number : 765-502-4000
Fax Number : 765-502-4709
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 10/23/2023

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