Provider Demographics
NPI:1962562595
Name:DENIS, ROBERTO O (MD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:O
Last Name:DENIS
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 1:1640 FORT STREET
Mailing Address - Street 2:SUITE D ATTN DENISE
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183
Mailing Address - Country:US
Mailing Address - Phone:734-391-3057
Mailing Address - Fax:734-391-3052
Practice Address - Street 1:2333 BIDDLE AVE
Practice Address - Street 2:
Practice Address - City:WYANDOTTE
Practice Address - State:MI
Practice Address - Zip Code:48192-4668
Practice Address - Country:US
Practice Address - Phone:734-246-6000
Practice Address - Fax:734-246-6000
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301038449207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI257721810Medicaid
MI1457586646OtherGROUP NPI HENRY FORD WYANDOTTE
MI0H24657OtherBLUE CROSS
MI257721810Medicaid
MI0H24657OtherBLUE CROSS
RD038449OtherCOMMERCIAL-COMMERCIAL NUMBER
0H26221042Medicare ID - Type Unspecified