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Organization

ELLEN M. ROTBLATT, M.D., P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ELLEN M ROTBLATT M.D. (PRESIDENT, BOARD CERTIFIED PSYCHIAT)
(734) 454-3560
Entity
Organization

Contact information

Practice address
705 SOUTH MAIN STREET, SUITE 280, PLYMOUTH, MI 48170-2089
(734) 454-3560
(734) 454-3570
Mailing address
705 SOUTH MAIN STREET, SUITE 280, PLYMOUTH, MI 48170-2089
(734) 454-3560
(734) 454-3570

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
4301052943
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11287336
CAQH
MI
01
193400000X
NPI SINGLE SPECIALTY TAXONOMY NUMBER
MI
01
2084P0800X
MEDICAL DR. TAXONOMY #
MI
01
4301052943
MEDICAL LICENSE NUMBER MI
MI
01
F16401
MEDICARE OPTED-OUT UPIN
MI
Enumeration date
07/08/2006
Last updated
12/01/2011
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