Provider Demographics
NPI:1710929948
Name:RABINOWITZ, BERTRAM B (DO)
Entity Type:Individual
Prefix:DR
First Name:BERTRAM
Middle Name:B
Last Name:RABINOWITZ
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 1:28080 GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-5966
Mailing Address - Country:US
Mailing Address - Phone:248-471-8982
Mailing Address - Fax:248-478-7179
Practice Address - Street 1:28080 GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-5966
Practice Address - Country:US
Practice Address - Phone:248-471-8982
Practice Address - Fax:248-478-7179
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101005007207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4033486OtherAETNA
MIB4460OtherMCARE
MI140066OtherCARE CHOICES
MI5631505OtherBLUE CROSS
MI4138960Medicaid
MI0F37175002Medicare PIN
MIM92370002Medicare PIN
MI4138960Medicaid