Provider Demographics
NPI:1386633766
Name:RONDINI, LOUIS L (DO)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:L
Last Name:RONDINI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25599 KELLY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROSEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48066-4975
Mailing Address - Country:US
Mailing Address - Phone:586-772-6000
Mailing Address - Fax:586-772-7700
Practice Address - Street 1:25599 KELLY RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROSEVILLE
Practice Address - State:MI
Practice Address - Zip Code:48066-4975
Practice Address - Country:US
Practice Address - Phone:586-772-6000
Practice Address - Fax:586-772-7700
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI006135208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4737849Medicaid
MICD7957OtherRAILROAD MEDICARE
MI$$$$$$$$$OtherTRICARE
MI4737849Medicaid