Individual
MR. ROBERT PETTAWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2995 E GRAND BLVD, DETROIT, MI 48202-3133
(313) 758-0150
Mailing address
2995 E GRAND BLVD, DETROIT, MI 48202-3133
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/25/2019
Last updated
09/25/2019
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