Provider Demographics
NPI:1467446633
Name:MICHAEL E ROLLINS MD
Entity Type:Organization
Organization Name:MICHAEL E ROLLINS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:313-882-1731
Mailing Address - Street 1:17770 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-6248
Mailing Address - Country:US
Mailing Address - Phone:313-882-1731
Mailing Address - Fax:313-881-1234
Practice Address - Street 1:17770 MACK AVE
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-6248
Practice Address - Country:US
Practice Address - Phone:313-882-1731
Practice Address - Fax:313-881-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMR026378207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2098524Medicaid
MI0408260841OtherBCBS
MI2098524Medicaid