Provider Demographics
NPI:1790749000
Name:RONTAL, EUGENE (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:RONTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33533 W 12 MILE RD STE 190
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5636
Mailing Address - Country:US
Mailing Address - Phone:248-865-3327
Mailing Address - Fax:248-737-0636
Practice Address - Street 1:33533 W 12 MILE RD STE 190
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48331-5636
Practice Address - Country:US
Practice Address - Phone:248-865-3327
Practice Address - Fax:248-737-0636
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
MI4301028146207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2650004Medicaid
MICI0239OtherRAILROAD MEDICARE
B45275Medicare UPIN
MI2650004Medicaid