Provider Demographics
NPI:1679736557
Name:ROBERT A ZOLTOWSKI DO PC
Entity type:Organization
Organization Name:ROBERT A ZOLTOWSKI DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZOLTOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-416-0780
Mailing Address - Street 1:580 FOREST AVE
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1780
Mailing Address - Country:US
Mailing Address - Phone:734-416-0780
Mailing Address - Fax:734-354-8624
Practice Address - Street 1:580 FOREST AVE
Practice Address - Street 2:SUITE 6B
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:734-416-0780
Practice Address - Fax:734-354-8624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010114382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3275276-11Medicaid
MIF81515Medicare UPIN