Provider Demographics
NPI:1518081116
Name:ZOLTOWSKI, ROBERT A (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:ZOLTOWSKI
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 1:580 FOREST AVE
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1780
Mailing Address - Country:US
Mailing Address - Phone:734-416-0780
Mailing Address - Fax:734-404-6280
Practice Address - Street 1:580 FOREST AVE
Practice Address - Street 2:SUITE 5B
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1780
Practice Address - Country:US
Practice Address - Phone:734-416-0780
Practice Address - Fax:734-404-6280
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010114382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2658235035OtherBCBSM
MIRZ011438OtherBCBSM PROVIDER ID
MIF81515Medicare UPIN
MIOM25950Medicare ID - Type Unspecified