Provider Demographics
NPI:1083667059
Name:ROBERT M DOTTERRER MD
Entity Type:Organization
Organization Name:ROBERT M DOTTERRER MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DOTTERRER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:231-935-2191
Mailing Address - Street 1:1221 6TH ST
Mailing Address - Street 2:SUITE#200
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2359
Mailing Address - Country:US
Mailing Address - Phone:231-935-2191
Mailing Address - Fax:231-935-2195
Practice Address - Street 1:1221 6TH ST
Practice Address - Street 2:SUITE#200
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2359
Practice Address - Country:US
Practice Address - Phone:231-935-2191
Practice Address - Fax:231-935-2195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0202810041OtherBCBS OF MI
MI1083667059OtherROBERT M DOTTERRER MD
MI1962403717OtherROBERT M DOTTERRER MD
MI0202810041OtherBLUE CARE NETWORK
MI1427054360OtherPAUL OLIVER MEMORIAL
MI1316991755OtherROBERT M DOTTERRER
MI1417931858OtherMAPLES NURSING HOME
MI1952307852OtherMUNSON MEDICAL CENTER
MI0B86018Medicare PIN
MI1427054360OtherPAUL OLIVER MEMORIAL