Basic Information
| Provider Information | |||||||||
| NPI: | 1598311334 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COGENT MEDICAL GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 28300 ORCHARD LAKE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343704 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 28300 ORCHARD LAKE RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483343704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2487374030 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2019 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | RONTAL | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 2487374030 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.