Provider Demographics
NPI:1689693590
Name:SUMMERS, ROSS ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALLEN
Last Name:SUMMERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1646
Mailing Address - Country:US
Mailing Address - Phone:248-349-1900
Mailing Address - Fax:248-349-3195
Practice Address - Street 1:308 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1646
Practice Address - Country:US
Practice Address - Phone:248-349-1900
Practice Address - Fax:248-349-3195
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301057732207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI127891OtherPREFERRED CHOICES
MICB2510OtherRAILROAD MEDICARE
MIOH24993OtherBLUE CROSS AND BLUE SHIELD
MI127891OtherPREFERRED CHOICES
MICB2510OtherRAILROAD MEDICARE