Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MR042031 | MI |
NPI | 1396729232 |
---|---|
Provider Name | Mark F Rottenberg |
First Address | Farmington Hills, MI 78334 |
Second Address | Farmington Hills, MI 48334-3704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10040231 | (05) | MI |
B43016 | (02) | MI |