Basic Information
| Provider Information | |||||||||
| NPI: | 1114946704 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RONTAL | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30701 WOODWARD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480730990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487374030 | ||||||||
| FaxNumber: | 2483077873 | ||||||||
| Practice Location | |||||||||
| Address1: | 30701 WOODWARD AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROYAL OAK | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480730990 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487374030 | ||||||||
| FaxNumber: | 2483077873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 02/03/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 4301075607 | MI | N | Other Service Providers | Specialist | 207Y00000X | 4301075607 | MI | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.