Provider Demographics
NPI:1841208592
Name:ESTUPIGAN, ROLANDO M (DO, PC)
Entity Type:Individual
Prefix:DR
First Name:ROLANDO
Middle Name:M
Last Name:ESTUPIGAN
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Gender:M
Credentials:DO, PC
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Mailing Address - Street 1:1777 AXTELL DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4404
Mailing Address - Country:US
Mailing Address - Phone:248-649-2430
Mailing Address - Fax:248-649-4303
Practice Address - Street 1:1777 AXTELL DR
Practice Address - Street 2:SUITE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4404
Practice Address - Country:US
Practice Address - Phone:248-649-2430
Practice Address - Fax:248-649-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101010979207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3370408Medicaid
MI3370408Medicaid
MIF83241Medicare UPIN