1083667059 NPI number — ROBERT M DOTTERRER MD

Table of content: (NPI 1083667059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083667059 NPI number — ROBERT M DOTTERRER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT M DOTTERRER MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083667059
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1221 6TH ST
Provider Second Line Business Mailing Address:
SUITE#200
Provider Business Mailing Address City Name:
TRAVERSE CITY
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49684-2359
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
231-935-2191
Provider Business Mailing Address Fax Number:
231-935-2195

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1221 6TH ST
Provider Second Line Business Practice Location Address:
SUITE#200
Provider Business Practice Location Address City Name:
TRAVERSE CITY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49684-2359
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
231-935-2191
Provider Business Practice Location Address Fax Number:
231-935-2195
Provider Enumeration Date:
05/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOTTERRER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PHYSICIANS
Authorized Official Telephone Number:
231-935-2191

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0202810041 . This is a "BCBS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1083667059 . This is a "ROBERT M DOTTERRER MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1962403717 . This is a "ROBERT M DOTTERRER MD" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0202810041 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1427054360 . This is a "PAUL OLIVER MEMORIAL" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1316991755 . This is a "ROBERT M DOTTERRER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1417931858 . This is a "MAPLES NURSING HOME" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1952307852 . This is a "MUNSON MEDICAL CENTER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".