Individual
DR. RONALD D PELAVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
28625 NORTHWESTERN HWY, SUITE 243, SOUTHFIELD, MI 48034-1828
(248) 358-2310
(248) 352-0734
Mailing address
28625 NORTHWESTERN HWY, SUITE 243, SOUTHFIELD, MI 48034-1828
(248) 358-2310
(248) 352-0734
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
4301038316
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0632560
BCBS INDIVIDUAL
MI
01
—
110202017
RR MEDICARE
MI
05
—
1700861366
—
MI
01
—
700F314390
BLUE SHIELD
MI
Enumeration date
12/07/2005
Last updated
02/17/2011
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