Healthcare Provider Details

I. General information

NPI: 1710912498
Provider Name (Legal Business Name): ROLAND F CHALIFOUX JR. DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34025 HARPER AVE
CLINTON TOWNSHIP MI
48035-3737
US

IV. Provider business mailing address

PO BOX 6115
WHEELING WV
26003-0737
US

V. Phone/Fax

Practice location:
  • Phone: 586-445-9900
  • Fax:
Mailing address:
  • Phone: 304-242-4004
  • Fax: 304-242-8004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number5101009950
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number5101009950
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number2077
License Number StateWV
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number34.016792
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: