Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 4301089817 | MI |
N | 207PE0004X | Emergency Medical Services | 4301089817 | MI |
NPI | 1174724793 |
---|---|
Provider Name | Garth B Rotman |
First Address | Chicago, IL 60689-5325 |
Second Address | Grand Rapids, MI 49503-2560 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 01/12/2011 |