Provider Demographics
NPI:1134111032
Name:ROOK, RONALD T (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:T
Last Name:ROOK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29900 LORRAINE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5266
Mailing Address - Country:US
Mailing Address - Phone:586-582-0864
Mailing Address - Fax:586-582-0964
Practice Address - Street 1:11012 E 13 MILE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2572
Practice Address - Country:US
Practice Address - Phone:586-582-0760
Practice Address - Fax:586-582-5729
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012705207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRR012705OtherBCBS PIN #
MI4528910Medicaid
H16868Medicare UPIN
MIRR012705OtherBCBS PIN #