Provider Demographics
NPI:1831486950
Name:ZOLOTOY, ROMAN
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:ZOLOTOY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SEAPORT DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1576
Mailing Address - Country:US
Mailing Address - Phone:248-390-3288
Mailing Address - Fax:
Practice Address - Street 1:20095 GILBERT RD STE B
Practice Address - Street 2:
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2366
Practice Address - Country:US
Practice Address - Phone:231-592-1360
Practice Address - Fax:231-592-1361
Is Sole Proprietor?:No
Enumeration Date:2011-07-10
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010195272081P2900X, 207R00000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110119479AMedicaid
MA110119479AMedicaid