Roth, Mark Samuel

Roth, Mark Samuel is an individual health care provider with primary practice located at 3601 W 13 Mile Rd Fsc, Royal Oak MI 48073-6712. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Roth, Mark Samuel can be contacted via phone (248) 423-2454.

Contact Information

Primary practice address
3601 W 13 Mile Rd Fsc Royal Oak MI 48073-6712
Phone: (248) 423-2454
Fax: (248) 423-2576
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 4301029387 Michigan

Profile Details

NPI number 1609927334
LBN Legal business name Roth, Mark Samuel
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 16th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1609927334 NPPES
Michigan Other 350F36132 BCBSM
Michigan MEDICAID 4815014 BCBSM

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