Provider Demographics
NPI:1972797892
Name:CZUBATYJ, ROMAN IVAN (MD)
Entity type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:IVAN
Last Name:CZUBATYJ
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Gender:
Credentials:MD
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Mailing Address - Street 1:1701 SOUTH BOULEVARD EAST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:ROCHESTER HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48307-1804
Mailing Address - Country:US
Mailing Address - Phone:248-853-0803
Mailing Address - Fax:248-852-5859
Practice Address - Street 1:1701 SOUTH BLVD E STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER HILLS
Practice Address - State:MI
Practice Address - Zip Code:48307-6118
Practice Address - Country:US
Practice Address - Phone:248-853-0803
Practice Address - Fax:248-852-5859
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2025-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301090701207RR0500X, 208000000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M76490467Medicare PIN