Healthcare Provider Details

I. General information

NPI: 1861661985
Provider Name (Legal Business Name): ENID ROBERTS MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 11/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33497 23 MILE RD SUITE 160
CHESTERFIELD MI
48047-4062
US

IV. Provider business mailing address

PO BOX 99251
TROY MI
48099-9251
US

V. Phone/Fax

Practice location:
  • Phone: 586-716-1702
  • Fax: 586-716-1706
Mailing address:
  • Phone: 586-716-1702
  • Fax: 586-716-1706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301057945
License Number StateMI

VIII. Authorized Official

Name: DR. ENID ROBERTS
Title or Position: PHYSCIAN/OWNER
Credential: MD
Phone: 586-716-1702