Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 5101012705 | MI |
NPI | 1134111032 |
---|---|
Provider Name | Ronald T Rook |
First Address | Warren, MI 48093-5266 |
Second Address | Warren, MI 48093-2572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2005 |
Last Update Date | 14/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4528910 | (05) | MI |
H16868 | (02) | |
RR012705 | BCBS PIN # (01) | MI |